Early TAVR or SAVR in asymptomatic patients linked to improved survival, reduced costs
Aortic valve replacement (AVR) in patients with asymptomatic severe aortic stenosis is associated with an increased likelihood of long-term survival and significant cost savings when compared to waiting for severe symptoms to develop, according to new real-world data presented at EuroPCR in Paris.
Researchers explored data from more than 24,000 U.S. patients who underwent either transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). Both TAVR and SAVR patients were treated with a variety of different valves.
Patients were split into one of three categories passed on the severity of their symptoms at the time of treatment. Patients with the most severe symptoms were categorized as having acute valve syndrome (AVS), mildly symptomatic patients were categorized as having progressive valve syndrome (PVS) and then asymptomatic patients were categorized as having stable valve syndrome (SVS).
While 56.5% of patients presented with AVS, another 42.3% presented with PVS and 1.1% presented with SVS. Mean patient ages were 72 years old for AVS, 70.1 years old for PVS and 65.9 years old for SVS. At least 60% of patients in all three groups were men. As one may expect, such complications as atrial fibrillation, hypertension and stroke were much more common among patients with AVS than those with PVS or SVS.
Overall, the group noted, AVR was associated with $36,267 less in one-year healthcare costs per patient for individuals who presented with SVS than those who treated with AVS. In fact, total costs after one year were $182,576 per AVS patient, $173.719 per PVS patient and $146,309 per SVS patient.
SVS/asymptomatic patients were also associated with shorter lengths of stay—more than two fewer days on average—and fewer follow-up heart failure hospitalizations within the first year of treatment.
In addition, the mortality rate was more than seven times higher for patients treated with severe symptoms than for those who presented with no symptoms.
“We continue to believe that watchful waiting is not an effective strategy for the management of severe aortic stenosis,” lead author Philippe Genereux, MD, director of the structural heart program at Gagnon Cardiovascular Institute at Morristown Medical Center, said in a statement. “The latest findings highlight the significant clinical and economic advantages of timely referral and treatment for severe aortic stenosis patients.”
More momentum for the treatment of asymptomatic aortic stenosis
Genereux presented these data just weeks after the U.S. Food and Drug Administration (FDA) approved the balloon-expandable Sapien 3 TAVR platform from Edwards Lifesciences for the treatment of asymptomatic severe aortic stenosis. That approval, based largely on research led by Genereux, has opened the door for U.S. patients without symptoms to undergo TAVR. In the past, these patients were always monitored with regular check-ups until symptoms started to emerge. At this time, no other TAVR valves have been approved for the treatment of asymptomatic aortic stenosis.
“We are dedicated to advancing robust evidence to help improve outcomes for patients with severe aortic stenosis,” Larry Wood, Edwards’ corporate vice president and group president of TAVR and surgical technologies, said in the same statement. “These latest findings underscore the importance of early referral to a heart valve team and timely care of patients with severe aortic stenosis, reducing the economic and resource burden for hospitals.”
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.