Determinants and Impact of Heart Failure Readmission Following Transcatheter Aortic Valve Replacement

Abstract

Background: Heart failure (HF) readmission is common post–transcatheter aortic valve replacement (TAVR). Nonetheless, limited data are available regarding its predictors and clinical impact. This study evaluated the incidence, predictors, and impact of HF readmission within 1-year post-TAVR, and assessed the effects of the prescription of HF therapies at discharge on the risk of HF readmission and death. Methods: Patients included in the TAVR registry of a single expert center from 2009 to 2017 were analyzed. Competing-risk and Cox regressions were performed to identify predictors of HF readmission and death. Results: Among 750 patients, 102 (13.6%) were readmitted for HF within 1-year post-TAVR. Overall, 53 patients (7.1%) experienced late readmissions (>30 days post-TAVR), and 17 (2.3%) had multiple readmissions. In ≈30% of readmissions, no trigger could be identified. Predominant causes of readmissions were changes in medication/nonadherence and supraventricular arrhythmia. Independent predictors of HF readmission included diabetes mellitus, chronic lung disease, previous acute HF, grade III or IV aortic regurgitation, and pulmonary hypertension both at discharge from the index hospitalization but not HF therapies. Overall, HF readmission did not significantly impact all-cause mortality (hazard ratio [HR], 1.36 [95% CI, 0.99–1.85]). However, late (HR, 1.90 [95% CI, 1.30–2.78]) and multiple HF readmissions (HR, 2.10 [95% CI,1.17–3.76]) were significantly associated with all-cause mortality. Prescription of renin-angiotensin system inhibitors at discharge was associated with a lower rate of all-cause mortality, especially among patients receiving doses of 25% to <50% (HR, 0.67 [95% CI, 0.48–0.94]) and 75% to 100% (HR, 0.61 [95% CI, 0.37–0.98]) of the optimal daily dose. Conclusions: HF readmission is common within 1-year of TAVR. Late and multiple HF readmissions associate with an increased risk of long-term all-cause mortality. Baseline comorbidities (diabetes, chronic lung disease, previous acute HF) and echocardiographic findings at discharge (grade III or IV aortic regurgitation, pulmonary hypertension) identified patients at high risk of HF readmission.

Mild aortic valve disease and the diastolic pressure–volume relationship in heart failure with preserved ejection fraction

“…This coexistence may explain the persistent heightened risk of heart failure readmissions and abnormal exercise haemodynamics after aortic valve intervention in many patients. 25 26 …”

Cardio-Ankle Vascular Index and Heart Failure Hospitalization in Patients With Aortic Stenosis Following Transcatheter Aortic Valve Implantation

“…10, 11 However, the occurrence of heart failure after TAVI remains an unsolved issue. 12 Several risk factors for the occurrence of heart failure after TAVI have been reported, including atrial fibrillation, low left ventricular ejection fraction (LVEF), ischemic heart disease, and pulmonary hypertension, 12,13 but the effect of vascular stiffness remains unknown.…”

Implications of Elevated Fibrosis-4 Index in Patients Receiving Trans-Catheter Aortic Valve Replacement

“…Recurrent heart failure following TAVR has negative prognostic implications [4]. Elevations in intra-cardiac filling pressures and the existence of refractory pulmonary hypertension are associated with poor outcomes following TAVR [11].…”

“…Survival following trans-catheter aortic valve replacement (TAVR) has improved considerably partly due to improvements in peri-procedural management and patient selection optimization [1,2]. Nevertheless, adverse events after TAVR can occur, including decompensated heart failure [3,4]. It is clinically challenging to ascertain predictive factors that are associated with heart failure recurrence following TAVR given the complex interplay of valvular and intrinsic myocardial dysfunction.…”