Causes, pattern, predictors, and prognostic implications of new hospitalizations after transcatheter aortic valve implantation: a long-term nationwide observational study

Abstract

Aim The aim of this study was to investigate the pattern, causes and predictors of all new hospitalizations in patients who underwent TAVI. Methods and results The nationwide Swedish TAVI-registry was merged with other mandatory health care registries, which enabled the analysis of all TAVI-procedures, new hospital admissions and death between the years 2008 and 2017. A total of 2821 patients underwent TAVI with a mean of 2.5 hospitalizations during a mean Follow-up of 2.2 years. Hospitalizations were associated with worse prognosis. Heart failure (HF) was the most common cause of hospitalization with 19% having at least one hospitalization due to HF causing 16% of all-cause admissions and 50% of cardiovascular admissions. Male gender, age > 90 years, high Charlson Comorbidity Index, atrial fibrillation, present neurologic disease, severe renal impairment, peripheral vascular disease, New York Heart Association class IV, mild or moderate mean aortic valve gradients and pulmonary hypertension were associated with an increased risk for all-cause hospitalizations or death. For cardiovascular hospitalization or death, the pattern was similar, with the addition of impaired systolic left ventricular function as a predictor. Conclusion Multiple hospitalizations after TAVI are common, and are often caused by HF. Reducing the rate of HF hospitalizations is important to mitigate the burden on the health care system due to new hospitalizations after TAVI.

Incidence and Risk Factors for Long-Term Persistence of Diastolic Dysfunction after Aortic Valve Replacement for Aortic Stenosis Compared with Aortic Regurgitation

“…Our study only evaluated the short- and medium-term evolution of patients with surgical AVR without taking into account the increasingly important population of those who benefit from transcatheter valve implantation (TAVI). Taking into account that multiple hospitalizations after TAVI are common and are often caused by HF, there are few studies trying to evaluate predictors and prognostic implications of new hospitalizations in the long term after TAVI [ 37 , 38 ]. However, substantial work is needed to obtain a standardized score that includes a limited number of variables that can be easily assessed during routine preoperative assessment and to test the predictive value of the models.…”

Patients' motivation to undergo transcatheter aortic valve replacement. A phenomenological hermeneutic study

“…This approach aims to mitigate the risks of geriatric deconditioning postoperatively, and nurse‐led support has proven to play a pivotal role in supporting patients during their short in‐hospital stay (Knoll et al, 2016 ; Lauck et al, 2020 ). However, Swedish registry data reveal that multiple hospitalisations after TAVR are common (Nilsson et al, 2022 ). Still, other studies report that TAVR patients' health improved within a short time after their treatment and that they were able to take part in daily activities to a greater extent than before the procedure (Astin et al, 2017 ; Lauck et al, 2020 ; Lysell & Wolf, 2021 ).…”