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Published on: May 26, 2023
End of Life After Transcatheter Aortic Valve Replacement: A Danish Nationwide Cohort Study
Jarl Emanuel Strange1, Anders Holt2, Daniel Mølager Christensen3
1Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark.
Background:
Survival after transcatheter aortic valve replacement (TAVR) has markedly increased. Thus, other comorbidities will intersect patient trajectories and challenge follow-up.
Objectives:
The aim of this study was to describe patient characteristics and hospitalizations at end of life to further improve the quality of life for patients undergoing TAVR.
Methods:
Using Danish nationwide registers, all patients who underwent TAVR were matched 1:10 at the time of death on age, sex, and calendar year of death to controls from the general population.
Results:
From 2008 to 2022, 2,544 TAVR patients who died were matched with 25,440 controls (median age 86 years, 55.1% males). Frailty and comorbidities were more prevalent in the TAVR group (eg, intermediate/high frailty: 2,200/2,544 [86.4%] vs 18,966/25,440 [74.6%]; heart failure: 1,407/2,544 [55.3%] vs 4,641/25,440 [18.2%]; chronic kidney disease: 633/2,544 [24.9%] vs 3,353/25,440 [13.2%]). In the last year of life, 650 of 2,544 patients (25.6%) in the TAVR group were hospitalized >28 days vs 4,160 of 25,440 (16.4%) for the controls. Of hospitalizations in the last year of life, 4,900 of 6,943 (70.6%) vs 38,833 of 49,438 (78.5%) were for a noncardiovascular cause, 1,253 of 6,943 (18.0%) vs 4,924 of 49,438 (10.0%) were cardiovascular, and 790 of 6,943 (11.4%) vs 5,681 of 49,438 (11.5%) were because of symptoms (eg, dyspnea, vomiting, or urine retention) in the TAVR group and the control group, respectively. Of cardiovascular hospitalizations, 529 of 1,253 (42.2%) vs 1,322 of 4,924 (26.8%) were because of heart failure in the TAVR group vs the controls.
Conclusions:
End of life for TAVR patients is characterized by high frailty and comorbidity burden. Importantly, most hospitalizations are of noncardiovascular cause, underscoring the need for a multidisciplinary approach toward end of life for TAVR patients. Future research is needed to improve follow-up and care in this patient population.
