Women who undergo transcatheter aortic valve replacement (TAVR) appear to face a higher risk of procedure-related ischemic stroke than men, according to new findings published in EuroIntervention.[1] Also, researchers noted, TAVR-related strokes are associated with a drop in clinical outcomes and higher healthcare costs.
Clinicians have continued to embrace TAVR as a treatment option for patients with severe symptomatic aortic stenosis, encouraged by study after study finding that it results in outcomes comparable to surgery. However, clinically significant strokes continue to be a complication seen in approximately 4% of TAVR patients.
“Prior studies have indicated that strokes are associated with increased short-term mortality and cost burden,” wrote first author Zaid I. Almarzooq, MBBCh, a specialist with Beth Israel Deaconess Medical Center and Brigham and Women’s Hospital, both in Boston, and colleagues.
“However, these studies were limited by their short follow-up, exclusive use of clinical trial data (which limits generalizability), and focused on only in-hospital costs.”
To learn more about this topic, researchers explored data from nearly 130,000 TAVR patients who were treated from January 2012 to December 2017. Patients who underwent multiple TAVR procedures only had their first procedure included in the analysis. While 52.7% of patients were men, 94% were white and 2.8% were Black.
All patients were Medicare fee-for-service beneficiaries at the time of the procedure, so the group focused on data from Medicare Provider Analysis and Review files and other CMS sources.
Overall, procedure-related ischemic stroke was seen in 4.3% of patients, consistent with trends clinicians have been observing for years. Fifty-one percent of patients with procedure-related stroke were women, 94.3% were white and 2.8% were black. These patients were also more likely to have a history of stroke, peripheral vascular disease, ischemic heart disease or renal failure.
After making certain adjustments, TAVR-related ischemic stroke was linked to a higher one-year risk of all-cause mortality, acute myocardial infarction and subsequent stroke. Also, as one might expect, these patients were associated with higher one-year Medicare expenditures — a difference of more than $9,000 per patient.
“These findings highlight TAVR-related ischemic stroke as a critically important and potentially preventable source of patient morbidity,” the authors wrote. “In addition, it informs clinicians, patients, and health systems on the health and economic consequences of TAVR-related ischemic stroke that will guide the evaluation of new strategies and devices intended to prevent them.”
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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.