TY - JOUR
T1 - Comorbidity burden and adverse outcomes after transcatheter aortic valve replacement
AU - Feldman, Daniel R.
AU - Romashko, Mikhail D.
AU - Koethe, Benjamin
AU - Patel, Sonika
AU - Rastegar, Hassan
AU - Zhan, Yong
AU - Resor, Charles D.
AU - Connors, Annie C.
AU - Kimmelstiel, Carey
AU - Allen, David
AU - Weintraub, Andrew R.
AU - Wessler, Benjamin S.
N1 - Publisher Copyright:
© 2021, American Heart Association Inc.. All rights reserved.
PY - 2021
Y1 - 2021
N2 - BACKGROUND: Transcatheter aortic valve replacement (TAVR) has become the preferred treatment for symptomatic patients with aortic stenosis and elevated procedural risk. Many deaths following TAVR are because of noncardiac causes and co-morbid disease burden may be a major determinant of postprocedure outcomes. The prevalence of comorbid conditions and associations with outcomes after TAVR has not been studied. METHODS AND RESULTS: This was a retrospective single-center study of patients treated with TAVR from January 2015 to October 2018. The association between 21 chronic conditions and short-and medium-term outcomes was assessed. A total of 341 patients underwent TAVR and had 1-year follow-up. The mean age was 81.4 (SD 8.0) years with a mean Society of Thoracic Surgeons predicted risk of mortality score of 6.7% (SD 4.8). Two hundred twenty (65%) patients had ≥4 chronic conditions present at the time of TAVR. There was modest correlation between Society of Thoracic Surgeons predicted risk of mortality and comorbid disease burden (r=0.32, P<0.001). After adjusting for Society of Thoracic Surgeons predicted risk of mortality, age, and vascular access, each additional comorbid condition was associated with increased rates of 30-day rehospitalizations (odds ratio, 1.21; 95% CI, 1.02–1.44), a composite of 30-day rehospitalization and 30-day mortality (odds ratio, 1.20; 95% CI, 1.02–1.42), and 1-year mortality (odds ratio, 1.29; 95% CI, 1.05–1.59). CONCLUSIONS: Comorbid disease burden is associated with worse clinical outcomes in high-risk patients treated with TAVR. The risks associated with comorbid disease burden are not adequately captured by standard risk assessment. A systematic assessment of comorbid conditions may improve risk stratification efforts.
AB - BACKGROUND: Transcatheter aortic valve replacement (TAVR) has become the preferred treatment for symptomatic patients with aortic stenosis and elevated procedural risk. Many deaths following TAVR are because of noncardiac causes and co-morbid disease burden may be a major determinant of postprocedure outcomes. The prevalence of comorbid conditions and associations with outcomes after TAVR has not been studied. METHODS AND RESULTS: This was a retrospective single-center study of patients treated with TAVR from January 2015 to October 2018. The association between 21 chronic conditions and short-and medium-term outcomes was assessed. A total of 341 patients underwent TAVR and had 1-year follow-up. The mean age was 81.4 (SD 8.0) years with a mean Society of Thoracic Surgeons predicted risk of mortality score of 6.7% (SD 4.8). Two hundred twenty (65%) patients had ≥4 chronic conditions present at the time of TAVR. There was modest correlation between Society of Thoracic Surgeons predicted risk of mortality and comorbid disease burden (r=0.32, P<0.001). After adjusting for Society of Thoracic Surgeons predicted risk of mortality, age, and vascular access, each additional comorbid condition was associated with increased rates of 30-day rehospitalizations (odds ratio, 1.21; 95% CI, 1.02–1.44), a composite of 30-day rehospitalization and 30-day mortality (odds ratio, 1.20; 95% CI, 1.02–1.42), and 1-year mortality (odds ratio, 1.29; 95% CI, 1.05–1.59). CONCLUSIONS: Comorbid disease burden is associated with worse clinical outcomes in high-risk patients treated with TAVR. The risks associated with comorbid disease burden are not adequately captured by standard risk assessment. A systematic assessment of comorbid conditions may improve risk stratification efforts.
KW - Cardiac disease
KW - Cardiovascular disease risk factors
KW - Clinical cardiology
KW - Transcatheter aortic valve implantation
UR - http://www.scopus.com/inward/record.url?scp=85106553607&partnerID=8YFLogxK
U2 - 10.1161/JAHA.120.018978
DO - 10.1161/JAHA.120.018978
M3 - Article
C2 - 33960198
AN - SCOPUS:85106553607
SN - 2047-9980
VL - 10
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 10
M1 - e018978
ER -