How depression, cognitive dysfunction impact long-term TAVR outcomes
Baseline depression and cognitive dysfunction (CD) are both independently associated with a higher risk of long-term mortality among patients undergoing transcatheter aortic valve replacement (TAVR), according to new findings published in Circulation: Cardiovascular Interventions.[1]
“In one multicenter study, nearly one-third of TAVR patients screened positive for baseline depression and this was independently associated with increased one-year mortality,” wrote first author Bassim Rashad El-Sabawi, MD, a senior resident with the division of cardiovascular medicine at Vanderbilt University Medical Center, and colleagues. “CD has been reported in 18% to 32% of TAVR patients using various assessment tools and has been associated with increased mid-term mortality. However, the associations of depression and CD with long-term post-TAVR mortality and quality of life (QoL) are unknown.”
El-Sabawi et al. examined data from nearly 900 patients who underwent TAVR at one of 11 U.S. facilities from May 2014 to February 2017. According to pre-TAVR screening, performed with “simple, validated screening tools,” depression was seen in 19.6% of patients, while CD was seen in 31.8%.
Patients with depression were more likely to be frail and present with a poor functional status. There was not a significant difference in aortic stenosis severity or procedural characteristics between patients with and without depression.
Patients with CD, meanwhile, were older and more likely to present with a prior dementia diagnosis. Again, there was no significant difference in aortic stenosis or procedural characteristics between patients with and without CD.
Overall, after a median follow-up period of nearly three years, both depression and CD were associated with a higher mortality rate. The mortality risk was highest among patients presenting with both depression and CD.
The analysis also examined QoL data using the Kansas City Cardiomyopathy Questionnaire. The presence of depression was associated with a lower QoL score one year after TAVR, but this was not true for CD.
Reviewing these findings, El-Sabawi et al. wrote that depression could represent a “modifiable therapeutic target to improve outcomes after TAVR.”
“Recognition of depression and CD may improve preprocedural risk stratification and inform prognostic discussions,” the authors wrote. “While the increased hazard of mortality associated with depression and CD is not high enough to suggest (on their own or together) futility of TAVR, the association of pre-TAVR depression with a lower one-year post-TAVR QoL, deemed up to moderate to large in magnitude, warrants broad screening efforts and points to the potential benefit of targeting this modifiable risk factor as an adjunct to treatment of AS with TAVR.”
The group also noted that it is unknown at this time if treating depression prior to TAVR would lead to better clinical outcomes or a “meaningful QoL change” after TAVR.
Additional research would be required to determine if this is the case.
Read the full study here.
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.