To delay or not to delay? When treating TAVR patients during the pandemic, heart teams faced big decisions
Delaying transcatheter aortic valve replacement (TAVR) for six months is associated with worse outcomes among both intermediate- and low-risk patients, according to a new research published in JTCVS Open. During the COVID-19 pandemic, however, there were still times when the smartest choice was to delay care for the patient and keep their risk of infection as low as possible.
After the pandemic first began, physicians all over the world were forced to weigh the risks of delaying medical treatment for certain procedures, including TAVR. But how were those decisions made? And did it affect patient outcomes? Those were two questions the team behind this study hoped to answer.
“The risk of delaying the treatment of symptomatic aortic stenosis (AS) must be balanced with the risk of mortality due to COVID-19 infection,” wrote lead author Daniel R. Freno, MD, a thoracic surgeon at Vanderbilt University Medical Center, and colleagues. “Early reports suggest that hospitalized patients, especially those with significant comorbidities such as cardiovascular and respiratory disease are at higher risk for complications including death from COVID-19 whether community or hospital acquired. Additionally, it has been well established that patients older than 60 years are at higher risk for complications and COVID-related mortality.”
Freno et al. developed a decision analysis model to compare the effect of either performing a prompt transfemoral TAVR during the pandemic or delaying treatment for six months. Available hospital resources and local infection rates were just two of the many factors specialists had to consider when making this decision.
After running numerous patient simulations, the authors found that prompt TAVR was associated with much better two-year outcomes than delayed TAVR among both intermediate- and low-risk patients with symptomatic severe AS during the COVID-19 pandemic. However, if the risk of infection surpassed 55% for intermediate-risk patients or 47% for low-risk patients, delaying TAVR was found to be the most “favorable” treatment option.
“COVID-19 is likely to continue to tax healthcare resources and a resurgence is a very likely possibility,” the authors concluded. “This decision analysis will help guide clinicians and healthcare systems when deciding how to triage TAVR patients based upon local prevalence of COVID-19.”
Click here for the full study.
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.