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Patients presenting with multiple chronic conditions face a greater risk of poor transcatheter aortic valve replacement (TAVR) outcomes, according to a new analysis of more than 350 high-risk patients. The full study was published in the Journal of the American Heart Association.
“Chronic conditions may decrease the absolute benefit of disease‐specific interventions by presenting competing risks,” wrote first author Daniel R. Feldman, MD, an internist at Tufts Medical Center in Boston, and colleagues. “For patients with cardiovascular disease, the most common comorbid conditions are hypertension, dyslipidemia, and diabetes mellitus. Chronic conditions for older adults with advanced cardiac disease, in particular those seeking interventional treatments, have not been systematically studied. TAVR, which has seen rapid adoption over the past few years, provides an opportunity to study chronic conditions for high‐risk patients with advanced cardiovascular disease.”
The team’s analysis focused on 358 patients who underwent TAVR from January 2015 to October 2018. One-year follow-up was available for 341 patients; the mean age of that group was 81.4 years old. Sixty-five percent of patients had more than four chronic conditions at the time of the procedure.
Overall, Feldman et al. found, each additional comorbid condition was associated with increased rates of 30-day hospitalization, 30-day mortality and one-year mortality.
The authors noted that a TAVR patient’s comorbid conditions should be included in any attempt to accurately assess their risks. These findings highlight that point.
“It is increasingly recognized that information about comorbid diseases should be considered when making treatment decisions for older adults with advanced cardiac disease,” the researchers wrote. “This issue is especially important in the context of treatment decisions for patients with structural heart disease since older adults with increased procedural risk are regularly treated with these advanced procedures. Comorbid disease burden has historically been difficult to define and quantify and as a result there is no consensus method of assessment.”
The National Institutes of Health helped fund this research. Click here to read the full analysis.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.