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Utilization and outcomes of aortic valve replacements (from the United States readmissions database)

Shashank Shekhar1, Abhishek Ajay1, Toshiaki Isogai1

  • 1Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA.

American Heart Journal Plus : Cardiology Research and Practice
|April 1, 2024
PubMed

Insights

Aortic valve replacement (AVR) is underutilized in heart failure patients with aortic stenosis (AS) and aortic regurgitation (AR). Most patients receive no AVR, despite worse outcomes, indicating a need for further research.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Health Services Research

Background:

  • Heart failure patients with concomitant aortic stenosis (AS) and/or aortic regurgitation (AR) represent a significant clinical challenge.
  • Optimal management strategies, including the utilization of aortic valve replacement (AVR), are not well-defined in this population.

Purpose of the Study:

  • To assess the utilization patterns of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) versus no-AVR in patients with heart failure and AS (CHF+AS) or AS with AR (CHF+AS+AR).

Main Methods:

  • Retrospective analysis of the Nationwide Readmissions Database (2016-2018).
  • Inclusion of patients with CHF+AS and CHF+AS+AR cohorts.
  • Comparison of AVR utilization (TAVI, SAVR, no-AVR) and short-term outcomes.

Main Results:

  • The majority of CHF+AS patients (79.9%) and CHF+AS+AR patients (53.2%) did not undergo AVR.
  • Among patients initially managed without AVR, only a small percentage (7.9% for CHF+AS, 11.8% for CHF+AS+AR) received AVR in the subsequent six months.
  • Patients managed without AVR experienced worse short-term outcomes compared to those who received AVR.

Conclusions:

  • Aortic valve replacement (AVR) is underutilized in heart failure patients with concomitant AS and/or AR.
  • Further research is necessary to elucidate optimal timing, indications, and utilization of AVR in this patient group.
  • Current management patterns suggest a potential gap in care, with non-intervention associated with poorer short-term outcomes.
Abstract

Keywords:
Aortic stenosisHeart failureSurgical aortic valve replacementTranscatheter aortic valve replacement

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