Chronic Conditions and Patient-Centered Outcomes After Transcatheter Aortic Valve Intervention

TL;DR

The study finds that patients with more chronic conditions have higher mortality after TAVI, but still experience significant quality of life improvements.

Contribution

This study quantifies the impact of chronic conditions on outcomes after TAVI and evaluates palliative care use.

Findings

Patients with ≥6 chronic conditions had 2.33 times higher 1-year mortality compared to those with <4 conditions.

Quality of life improvements after TAVI were substantial and largely independent of chronic disease burden.

Palliative care use varied widely across centers, with only 4.7% of patients receiving it.

Abstract

Transcatheter aortic valve intervention (TAVI) has revolutionized the care of older adults with aortic stenosis.

The objectives of the study were to examine associations between chronic conditions and outcomes after TAVI and to describe palliative care utilization rates.

This cohort study used the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy registry to identify patients who underwent TAVI and were eligible for linkage with Centers for Medicare & Medicaid Services claims data. The exposure was multiple chronic conditions (MCCs) in the year before TAVI. Associations between chronic conditions and outcomes were assessed using multivariable logistic regression.

A total of 188,629 TAVI procedures were linked to Centers for Medicare & Medicaid Services claims. The median (IQR) age was 82.0 (76.0-87.0) years; 86,841 (46%) were female. Chronic conditions were associated with worse 1-year mortality (high MCC [≥6 conditions] vs low MCC [<4 chronic conditions], adjusted HR: 2.33 [95% CI: 2.22-2.44]). Chronic conditions were associated with lower Kansas City Cardiomyopathy Questionnaire at baseline (high MCC median score 37.5 [21.4-56.8] vs low MCC median score 55.7 [37.5-75.0], P < 0.001); however, the average improvement in Kansas City Cardiomyopathy Questionnaire after TAVI was large and appeared independent of chronic disease burden (median score change high MCC 28.7 [9.9-48.4] vs low MCC 24.5 [8.3-42.2], standardized difference +13.8%). Palliative care encounters were rare (8,946, 4.7%) and varied significantly across centers (range 0% to 25% of cases).

Chronic conditions are associated with worse survival after TAVI. However, most patients with high MCC are alive 1 year after treatment, and quality of life improvements appear independent of chronic disease burden. These data help clarify expected health gains for patients with chronic conditions and symptomatic aortic stenosis.

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