Early Postrranscatheter Aortic Valve Replacement Heart Failure Hospitalization and Outcomes in Older Patients

Transcatheter aortic valve replacement (TAVR) improves symptoms and survival in patients with severe aortic stenosis, yet the incidence and prognostic significance of early postprocedural heart failure (HF) hospitalization remain incompletely characterized. Our objective is to determine the incidence, clinical characteristics, prognostic implications, and predictors of early HF hospitalization after TAVR.

Using the Medicare Provider Analysis and Review database, we identified fee-for-service beneficiaries ≥65 years who underwent TAVR between January 1, 2017, and November 30, 2021. Early post-TAVR HF hospitalization was defined as at least 1 HF readmission occurring between 31 and 365 days after the index procedure. Patients were classified according to the presence or absence of HF hospitalization during this period. Cox proportional hazards models were used to evaluate the association with mortality after adjustment for clinical, procedural, and sociodemographic factors.

Among 233 309 patients undergoing TAVR, 45 502 (19.5%) experienced HF hospitalization within 1 year. Patients with early HF hospitalization had markedly higher mortality compared with those without HF hospitalization, including 1-year mortality (43.8% versus 3.6%) and 5-year mortality (80.6% versus 41.0%) (log-rank P<0.001). After multivariable adjustment, early HF hospitalization was strongly associated with increased mortality (adjusted hazard ratio [HR], 3.17 [95% CI, 3.11-3.22]). The strongest predictors of early HF hospitalization were advanced cardiac damage stage (adjusted-subdistribution HR, 1.95 [95% CI, 1.88-2.02]) and high-risk frailty (adjusted-subdistribution HR, 1.65 [95% CI, 1.58-1.72]), with graded risk across stages.

Nearly 1 in 5 older adults undergoing TAVR experience early HF hospitalization, which is associated with markedly increased short- and long-term mortality.