Why cardiologists should pay close attention to rehospitalizations after TAVR or SAVR
Rehospitalization after aortic valve replacement (AVR) is associated with an increased risk of patient mortality, according to new findings published in the Circulation: Cardiovascular Interventions.[1] This suggests that researchers should continue tracking rehospitalization rates for patients who undergo transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) going forward.
“Recently, heart failure hospitalizations (HFHs) and composite end points including HFHs, valve-related or procedure-related events have taken on increased importance as endpoints in trials of structural heart interventions,” wrote first author Chetan P. Huded, MD, MSc, a cardiologist with Saint Luke’s Mid America Heart Institute in Kansas City, Missouri, and colleagues. “However, the prognostic importance of rehospitalizations in these patients after AVR remains uncertain. Specifically, it is unclear whether these are transient events or whether they are important markers that identify patients who are at higher risk for worse long-term outcome.”
Huded et al. examined data from nearly 3,5000 patients who were treated with TAVR or SAVR as part of the PARTNER, PARTNER 2 or PARTNER 3 trials. While 2,008 patients underwent TAVR, the other 1,395 patients underwent SAVR.
The cohort’s one-year HFH rate was 6.7%. The one-year rate of rehospitalization due to the composite endpoint of heart failure, valve-related events or procedure-related events was 9.7%.
Overall, the group confirmed that both HFH and the composite endpoint were both associated with an increased risk of patient mortality after one year. They were also linked to a heightened risk of a poor outcome or lower Kansas City Cardiomyopathy Questionnaire score.
The treatment type—whether these patients underwent TAVR or SAVR—did not appear to impact these associations between rehospitalization and final outcome.
The study’s authors shared another key takeaway from their research: a low aortic valve mean gradient, atrial fibrillation and prior coronary revascularization before AVR all increase a patient’s risk of experiencing a post-AVR HFH.
“Despite careful patient selection, residual heart failure symptoms after AVR may persist,” the group wrote. “Early identification of patients with residual heart failure symptoms and multidisciplinary management of these patients with guideline-directed heart failure therapy may provide an opportunity to improve long-term outcomes.”
Moving forward, the authors added, researchers should continue closely tracking rehospitalization events after AVR procedures.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.