Patient-defined Outcomes in Cardiovascular Surgery and Interventions

As cardiovascular patients live longer and undergo increasingly complex procedures, relying solely on mortality as benchmark of success is no longer sufficient. While patient-reported outcomes incorporate quality of life, symptoms, and functional status, they are often clinician-framed, lengthy, and difficult to integrate into routine care. Patient-defined outcomes is a patient-led evolution of this concept that emphasizes priorities such as autonomy and independence and avoiding outcomes deemed so undesirable that patients would sacrifice longevity to prevent them. Disability-free survival and patient-defined adverse cardiovascular and noncardiovascular events are composite patient-defined outcomes codeveloped with patients. Unlike patient-reported outcomes, which can be unwieldy, patient-defined outcomes are interpretable, autonomy-centered endpoints that extend beyond survival and traditional quality-of-life questionnaires. Integrating these measures into cardiac surgical and interventional workflows, especially during preoperative assessment and tailored optimization, helps align care with patient goals. Patient-defined outcomes have the potential to transform perioperative care by shifting the focus from living longer to living better.