Comorbidity Burden and Adverse Outcomes After Transcatheter Aortic Valve Replacement
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 comorbid disease burden may be a major determinant of postprocedure...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-05-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.018978 |
| _version_ | 1797301672165244928 |
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| author | Daniel R. Feldman Mikhail D. Romashko Benjamin Koethe Sonika Patel Hassan Rastegar Yong Zhan Charles D. Resor Annie C. Connors Carey Kimmelstiel David Allen Andrew R. Weintraub Benjamin S. Wessler |
| author_facet | Daniel R. Feldman Mikhail D. Romashko Benjamin Koethe Sonika Patel Hassan Rastegar Yong Zhan Charles D. Resor Annie C. Connors Carey Kimmelstiel David Allen Andrew R. Weintraub Benjamin S. Wessler |
| author_sort | Daniel R. Feldman |
| collection | DOAJ |
| description | 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 comorbid 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. |
| first_indexed | 2024-03-07T23:25:55Z |
| format | Article |
| id | doaj.art-9fef6a8a24d44aacb9b1a23814282ff2 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-07T23:25:55Z |
| publishDate | 2021-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-9fef6a8a24d44aacb9b1a23814282ff22024-02-21T04:33:36ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-05-01101010.1161/JAHA.120.018978Comorbidity Burden and Adverse Outcomes After Transcatheter Aortic Valve ReplacementDaniel R. Feldman0Mikhail D. Romashko1Benjamin Koethe2Sonika Patel3Hassan Rastegar4Yong Zhan5Charles D. Resor6Annie C. Connors7Carey Kimmelstiel8David Allen9Andrew R. Weintraub10Benjamin S. Wessler11Department of Internal Medicine Tufts Medical Center Boston MADivision of Cardiology Tufts Medical Center Boston MAInstitute for Clinical Research and Health Policy Studies Biostatistics, Epidemiology, and Research Design (BERD) Center Tufts Medical Center Boston MADepartment of Internal Medicine University of Maryland Baltimore MDDivision of Cardiothoracic Surgery Tufts Medical Center Boston MADivision of Cardiothoracic Surgery Tufts Medical Center Boston MADivision of Cardiology Tufts Medical Center Boston MADivision of Cardiology Tufts Medical Center Boston MADivision of Cardiology Tufts Medical Center Boston MADepartment of Interventional Radiology Tufts Medical Center Boston MADivision of Cardiology Tufts Medical Center Boston MADivision of Cardiology Tufts Medical Center Boston MABackground 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 comorbid 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.https://www.ahajournals.org/doi/10.1161/JAHA.120.018978cardiac diseasecardiovascular disease risk factorsclinical cardiologytranscatheter aortic valve implantation |
| spellingShingle | Daniel R. Feldman Mikhail D. Romashko Benjamin Koethe Sonika Patel Hassan Rastegar Yong Zhan Charles D. Resor Annie C. Connors Carey Kimmelstiel David Allen Andrew R. Weintraub Benjamin S. Wessler Comorbidity Burden and Adverse Outcomes After Transcatheter Aortic Valve Replacement Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiac disease cardiovascular disease risk factors clinical cardiology transcatheter aortic valve implantation |
| title | Comorbidity Burden and Adverse Outcomes After Transcatheter Aortic Valve Replacement |
| title_full | Comorbidity Burden and Adverse Outcomes After Transcatheter Aortic Valve Replacement |
| title_fullStr | Comorbidity Burden and Adverse Outcomes After Transcatheter Aortic Valve Replacement |
| title_full_unstemmed | Comorbidity Burden and Adverse Outcomes After Transcatheter Aortic Valve Replacement |
| title_short | Comorbidity Burden and Adverse Outcomes After Transcatheter Aortic Valve Replacement |
| title_sort | comorbidity burden and adverse outcomes after transcatheter aortic valve replacement |
| topic | cardiac disease cardiovascular disease risk factors clinical cardiology transcatheter aortic valve implantation |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.018978 |
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