Prognostic Value of Patient-Reported Outcomes in Predicting Long-term Mortality after Transcatheter Aortic Valve Replacement (TAVR)

Abstract

Background: Patient-reported outcome measures (PROM) have been shown to have important prognostic value after various cardiac interventions. We assessed the association between the change in Kansas City Cardiomyopathy Questionnaire 12 (KCCQ-12) score after transcatheter aortic valve replacement (TAVR) and mortality. Methods: We included patients who underwent TAVR at Mayo Clinic between February 2012, and June 2022, who completed KCCQ-12 prior to and 30-45 days after the procedure. Patients were categorized into 3 groups: those who experienced significant (≥19 points; group-1), modest (1-19 points; group-2), and no improvement (≤0 points; group-3). Results: A total of 1,124 patients were included: 60.8% males; 97.6% Caucasian. Mean age was 79.4±8.3 years, KCCQ-12 score was 53.9±24.5, and median STS score was 4.9% (interquartile range 3.1-8.0). At 45 days, the mean change in KCCQ-12 score was 19±24 points: 46.3% (n= 520) of patients had a significant improvement in their KCCQ-12 score, while 33.4% (n= 375) and 20.4% (n = 229) had modest and no improvement, respectively. Median survival was higher in group-1 (5.7±0.2 years) compared to groups 2 and 3 (5.1±0.3 and 4.1±0.4 years, respectively; P<.001). Compared to patients in group 1, those in groups 2 and 3 had higher long-term risk-adjusted mortality (adjusted hazard ratio 1.64; 95%CI 1.28-2.10, and 2.44; 95%CI, 1.84-3.24, respectively). Conclusion: Patients who experience modest or no improvement in KCCQ-12 score after TAVR have substantially higher long-term mortality. Delta KCCQ-12 is a cost-effective, efficient tool that can identify patients at increased risk of death at long-term follow-up post-TAVR.