‘A victory for TAVR’: How treatment impacts elderly patients in their last year of life
Elderly patients who have undergone transcatheter aortic valve replacement (TAVR) may face an increased hospitalization risk during their last year of life, according to new data published in JACC: Cardiovascular Interventions.[1] However, researchers emphasized, such complications are largely unrelated to heart health; this suggests that general frailty and various comorbidities are to blame, not aortic stenosis or any issues related to TAVR itself.
A team of specialists out of Denmark explored data from more than 2,500 TAVR patients who survived the first year after treatment and then died from 2008 to 2022. The median age was 86 years old, 54.7% were men and the median time from TAVR to death was 3.9 years. This group was compared to more than 25,000 patients who died during the same period and had never undergone TAVR. The median age of that group was 86 years old and 54.7% were men, just like the group of TAVR patients. The groups were similar in other ways as well, though TAVR patients were still more likely to present with significant frailty and comorbidities such as heart failure and chronic kidney disease.
Overall, the group found that 25.6% of the TAVR group and 16.4% of the control group were hospitalized in their last year of life. Of those hospitalizations, 70.6% were for noncardiovascular reasons in the TAVR group and 78.5% were for noncardiovascular reasons in the control group.
“End of life for TAVR patients is characterized by high frailty and comorbidity burden,” wrote first author Jarl Emanuel Strange, MD, PhD, a cardiologist with Copenhagen University Hospital, and colleagues. “Importantly, most hospitalizations are of noncardiovascular cause, underscoring the need for a multidisciplinary approach toward end of life for TAVR patients. Future research is needed to improve follow-up and care in this patient population.”
‘TAVR has achieved its goal’
A veteran interventional cardiologist reviewed these data in a separate editorial for JACC: Cardiovascular Interventions, writing that they should be “viewed as a victory for TAVR.”[1]
“Although the need for medical care and the likelihood of hospitalization at the end of life are greater for patients who have undergone TAVR, the absolute differences between the groups are not overwhelming,” wrote Neal S. Kleiman, MD, chief of interventional cardiology and medical director of the cardiac cath labs at Houston Methodist DeBakey Heart & Vascular Center. “The study suggests strongly that the hospitalizations result from frailty and comorbidities rather than consequences of the original aortic valve disease. In other words, TAVR has restored patients to a status that is comparable to that of the generalized elderly population. One might speculate that as TAVR valves and operator skills have improved, the difference in cardiovascular mortality will narrow, and might be reduced further by TAVR earlier in the natural history of aortic stenosis and by investigation of adjunctive medications. Thus, TAVR has achieved its goal in this population, but has unmasked other factors that pose a serious challenge in caring for the elderly.”
Kleiman did note that this research excluded TAVR patients who did not survive the first year after treatment. He also emphasized that TAVR is being used more and more to treat younger patients, which leads to additional questions about the end of life in those individuals.
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.