TAVR death rate rises to 23.7 percent at 1 year in registry analysis

Updating a prior report on 30-day transcatheter aortic valve replacement (TAVR) outcomes of Medicare patients, researchers found several characteristics significantly associated with one-year mortality, according to an article published March 10 in JAMA.

David R. Holmes Jr, MD, of the Mayo Clinic in Rochester, Minn., and colleagues linked data from the Transcatheter Valve Therapies registry from 2011 through 2013 and Medicare claims data for their analysis. Follow-up ended in June 2014.

As reported previously, 59.8 percent of patients were discharged home following the procedure and 30-day mortality was 7 percent. After six months, mortality increased to 16.7 percent. At one year, mortality was 23.7 percent; stroke occurred in 4.1 percent of patients. The composite of stroke or death at one year was 26 percent.

At the one-year mark, patients were reported to be alive and out of the hospital a median of 353 days. One rehospitalization occurred for 24.4 percent of participants. Two rehospitalizations occurred for 12.5 percent; 11.6 percent of patients were rehospitalized three or more times within the first year. A composite of stroke, repeat aortic valve intervention or heart failure was the cause for readmission for 18.6 percent of patients. However 46.8 percent of patients still alive at the one-year after TAVR had not been rehospitalized.

Factors that influenced one-year mortality included being male (hazard ratio 1.21), preoperative atrial fibrillation or flutter (1.37), nontransfemoral access (1.37), severe lung disease (1.39), advanced age (1.35 for patients between 85 and 94 years old, 1.61 for patients 95 years or older), renal failure (1.66) and increasing baseline Society of Thoracic Surgeons Predicted Risk of Operative Mortality score (1.82). Women had higher risk of stroke than men (1.4).

Holmes et al noted that knowing the risk factors should help physicians identify and counsel patients when considering TAVR, particularly in patients at very high risk.

“However, even though mortality is high at one year in this group, quality of life and the potential to decrease rehospitalizations for congestive heart failure are important additional issues to be considered. The low event numbers in this exploratory analysis mandate that caution should be used in applying these data to decisions regarding patient selection,” Holmes et al wrote.