Impact of Cause-Specific readmission on Long-Term mortality after transcatheter aortic valve implantation

Hospital readmissions after transcatheter aortic valve implantation (TAVI) are common, yet the long-term impact of both readmission for heart failure and non-cardiac readmissions, including infection, fracture, and stroke, on mortality remains insufficiently understood.

This retrospective cohort study included 1,008 patients (mean age 85 ± 5 years; 325 [32%] male) who underwent TAVI between January 2014 and December 2024. Cardiac readmission was defined as readmission for heart failure, whereas non-cardiac readmissions were defined as those due to infection, fracture, and stroke. Cause-specific cumulative incidence functions were estimated using the Fine-Gray model, with death treated as a competing risk, and the associations between each type of readmission and all-cause mortality were evaluated using time-dependent Cox proportional hazards models. During the observation period, 253 patients (26%) died. The 10-year cumulative incidence rates were 38% for heart failure, 10% for infection, 23% for fracture, and 9% for stroke. Although infection-, fracture-, and stroke-related readmissions occurred less frequently than mortality as a competing risk, all were significantly associated with increased all-cause mortality: heart failure (HR 5.54, 95% CI 3.99-7.69), infection (HR 5.00, 95% CI 2.81-8.89), stroke (HR 5.69, 95% CI 3.39-9.54), and fracture (HR 4.47, 95% CI 2.90-6.09) (all p < 0.01). Most readmissions occurred within the first year, while fracture-related readmissions showed a secondary rise around the second year, and all event types increased again after the third year.

Hospital readmissions following TAVI, including both cardiac and non-cardiac causes, were significantly associated with increased all-cause mortality.