TAVR timing: Waiting more than 6 months may hurt survival odds
When heart patients are diagnosed with severe aortic stenosis (AS), waiting any longer than six months to perform transcatheter aortic valve replacement (TAVR) is associated with worse long-term outcomes. That was the key takeaway from a new analysis published in Open Heart.[1]
The study’s authors highlighted the fact that asymptomatic severe AS is increasingly being treated. At the same time, however, it is still common for patients to wait and then undergo a follow-up clinical and imaging exam six to 12 months later. The group hoped to learn more about the potential impact TAVR timing may have on patient outcomes, performing a retrospective study on data from 149 patients treated at a single facility from 2021 to 2023. The mean age was 85.8 years old, and 36% of patients were men.
Overall, 67% of patients were treated within six months of receiving a diagnosis of severe AS and the other 33% were treated more than six months after receiving their diagnosis. Among those patients who were treated more than six months later, the median time from diagnosis to TAVR was 13 months. Patients in the early TAVR group were less likely to present with a history of stroke, but most other baseline characteristics were comparable between the two groups.
Overall, after a median follow-up period of approximately two years, the study’s primary composite endpoint—all-cause mortality or heart failure hospitalization—occurred in 16% of the early TAVR group and 33% of the delayed TAVR group. A composite of cardiac mortality or heart failure hospitalization, meanwhile, was not significantly different between these two groups.
In addition, the group noted, follow-up clinical and echocardiographic exams one year after TAVR identified no significant differences between these two groups.
“Our findings suggest that when the interval between diagnosis and intervention exceeds 6 months, the observed risk of the primary endpoint is higher, with this difference largely related to non-cardiac mortality,” wrote first author Ayumi Omuro, a cardiology researcher with Yamaguchi University School of Medicine in Japan, and colleagues. “These results highlight the importance of timely reassessment of patients with severe AS and may help inform clinical decision-making regarding the appropriate timing of intervention.”
Omuro et al. noted that their research confirmed a trend seen in other studies as well; older patients often defer treatment at first due to frailty, other health issues, fear of undergoing the procedure or family concerns. The group also emphasized that additional research is still required to learn more about the optimal timing for real-world heart patients who require TAVR.
“A persistent gap remains between the evidence supporting early intervention and the complex, multifactorial decision-making encountered in everyday practice,” the authors wrote. “Understanding these factors is essential for developing patient-centered strategies that support timely evaluation while respecting individual preferences.”
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.