TY - JOUR
T1 - End of Life After Transcatheter Aortic Valve Replacement
T2 - A Danish Nationwide Cohort Study
AU - Strange, Jarl Emanuel
AU - Holt, Anders
AU - Christensen, Daniel Mølager
AU - Nouhravesh, Nina
AU - Petersen, Jeppe Kofoed
AU - Bække, Pernille Steen
AU - De Backer, Ole
AU - Schou, Morten
AU - Køber, Lars
AU - Fosbøl, Emil Loldrup
N1 - Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.
PY - 2024/12/23
Y1 - 2024/12/23
N2 - BACKGROUND: Survival after transcatheter aortic valve replacement (TAVR) has markedly increased. Thus, other comorbidities will intersect patient trajectories and challenge follow-up.OBJECTIVES: The aim of this study was to describe patient characteristics and hospitalizations at end of life to further improve the quality of life for patients undergoing TAVR.METHODS: Using Danish nationwide registers, all patients who underwent TAVR were matched 1:10 at the time of death on age, sex, and calendar year of death to controls from the general population.RESULTS: From 2008 to 2022, 2,544 TAVR patients who died were matched with 25,440 controls (median age 86 years, 55.1% males). Frailty and comorbidities were more prevalent in the TAVR group (eg, intermediate/high frailty: 2,200/2,544 [86.4%] vs 18,966/25,440 [74.6%]; heart failure: 1,407/2,544 [55.3%] vs 4,641/25,440 [18.2%]; chronic kidney disease: 633/2,544 [24.9%] vs 3,353/25,440 [13.2%]). In the last year of life, 650 of 2,544 patients (25.6%) in the TAVR group were hospitalized >28 days vs 4,160 of 25,440 (16.4%) for the controls. Of hospitalizations in the last year of life, 4,900 of 6,943 (70.6%) vs 38,833 of 49,438 (78.5%) were for a noncardiovascular cause, 1,253 of 6,943 (18.0%) vs 4,924 of 49,438 (10.0%) were cardiovascular, and 790 of 6,943 (11.4%) vs 5,681 of 49,438 (11.5%) were because of symptoms (eg, dyspnea, vomiting, or urine retention) in the TAVR group and the control group, respectively. Of cardiovascular hospitalizations, 529 of 1,253 (42.2%) vs 1,322 of 4,924 (26.8%) were because of heart failure in the TAVR group vs the controls.CONCLUSIONS: End of life for TAVR patients is characterized by high frailty and comorbidity burden. 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.
AB - BACKGROUND: Survival after transcatheter aortic valve replacement (TAVR) has markedly increased. Thus, other comorbidities will intersect patient trajectories and challenge follow-up.OBJECTIVES: The aim of this study was to describe patient characteristics and hospitalizations at end of life to further improve the quality of life for patients undergoing TAVR.METHODS: Using Danish nationwide registers, all patients who underwent TAVR were matched 1:10 at the time of death on age, sex, and calendar year of death to controls from the general population.RESULTS: From 2008 to 2022, 2,544 TAVR patients who died were matched with 25,440 controls (median age 86 years, 55.1% males). Frailty and comorbidities were more prevalent in the TAVR group (eg, intermediate/high frailty: 2,200/2,544 [86.4%] vs 18,966/25,440 [74.6%]; heart failure: 1,407/2,544 [55.3%] vs 4,641/25,440 [18.2%]; chronic kidney disease: 633/2,544 [24.9%] vs 3,353/25,440 [13.2%]). In the last year of life, 650 of 2,544 patients (25.6%) in the TAVR group were hospitalized >28 days vs 4,160 of 25,440 (16.4%) for the controls. Of hospitalizations in the last year of life, 4,900 of 6,943 (70.6%) vs 38,833 of 49,438 (78.5%) were for a noncardiovascular cause, 1,253 of 6,943 (18.0%) vs 4,924 of 49,438 (10.0%) were cardiovascular, and 790 of 6,943 (11.4%) vs 5,681 of 49,438 (11.5%) were because of symptoms (eg, dyspnea, vomiting, or urine retention) in the TAVR group and the control group, respectively. Of cardiovascular hospitalizations, 529 of 1,253 (42.2%) vs 1,322 of 4,924 (26.8%) were because of heart failure in the TAVR group vs the controls.CONCLUSIONS: End of life for TAVR patients is characterized by high frailty and comorbidity burden. 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.
KW - Humans
KW - Transcatheter Aortic Valve Replacement/adverse effects
KW - Denmark/epidemiology
KW - Male
KW - Female
KW - Aged, 80 and over
KW - Registries
KW - Time Factors
KW - Aged
KW - Risk Factors
KW - Treatment Outcome
KW - Aortic Valve Stenosis/surgery
KW - Comorbidity
KW - Quality of Life
KW - Frailty/diagnosis
KW - Risk Assessment
KW - Aortic Valve/surgery
KW - Frail Elderly
KW - Hospitalization
KW - Prevalence
UR - http://www.scopus.com/inward/record.url?scp=85211497939&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2024.09.021
DO - 10.1016/j.jcin.2024.09.021
M3 - Journal article
C2 - 39722275
SN - 1936-8798
VL - 17
SP - 2936
EP - 2946
JO - JACC. Cardiovascular interventions
JF - JACC. Cardiovascular interventions
IS - 24
ER -