Incidence of, risk factors for and impact of readmission for heart failure after successful transcatheter aortic valve implantation

Paul Guedeney; François Huchet; Thibaut Manigold; Stéphanie Rouanet; Pauline Balagny; Pascal Leprince; Guillaume Lebreton; Vincent Letocart; Olivier Barthelemy; Eric Vicaut; Gilles Montalescot; Patrice Guerin; Jean-Philippe Collet; ACTION Study Group

doi:10.1016/j.acvd.2019.09.008

Incidence of, risk factors for and impact of readmission for heart failure after successful transcatheter aortic valve implantation

Arch Cardiovasc Dis. 2019 Dec;112(12):765-772. doi: 10.1016/j.acvd.2019.09.008. Epub 2019 Nov 20.

Affiliations

¹ ACTION Study Group, Inserm UMRS 1166, institut de cardiologie, Sorbonne université, hôpital universitaire Pitié-Salpêtrière, AP-HP, 75013 Paris, France.
² Cardiology department, Nantes university hospital, 44000 Nantes, France.
³ Statistician unit, StatEthic, 92300 Levallois-Perret, France.
⁴ ACTION Study Group, unité de recherche clinique, hôpital Lariboisière, AP-HP, 75010 Paris, France.
⁵ ACTION Study Group, Inserm UMRS 1166, institut de cardiologie, Sorbonne université, hôpital universitaire Pitié-Salpêtrière, AP-HP, 75013 Paris, France. Electronic address: jean-philippe.collet@aphp.fr.

PMID: 31759916
DOI: 10.1016/j.acvd.2019.09.008

Abstract

Background: The incidence of and risk factors for readmission for heart failure after successful transcatheter aortic valve implantation (TAVI) are unclear.

Aims: We sought to evaluate the incidence of, risk factors for and clinical impact of readmission for heart failure after successful TAVI in an unselected patient population.

Methods: All patients who underwent successful TAVI in two high-volume French tertiary centres from February 2010 to December 2016 were included prospectively and followed up for 1 year. A Cox multivariable model was used to assess risk factors for readmission for heart failure and mortality.

Results: A total of 1139 patients (mean age 82.4±7.7years; 52.2% male sex) were included. Readmission for heart failure occurred in 99 (9.2%) patients. Risk factors for readmission for heart failure were previous atrial fibrillation (adjusted hazard ratio [_adjHR] 1.62, 95% confidence interval [CI] 1.09-2.40), diabetes mellitus (_adjHR 1.67, 95% CI 1.11-2.50), chronic kidney disease (_adjHR 1.72, 95% CI 1.13-2.62), chronic pulmonary disease (_adjHR 1.81, 95% CI 1.17-2.81) and left ventricular ejection fraction after TAVI ≤ 35% (_adjHR 2.12, 95% CI 1.20-3.75). Readmission for heart failure was strongly associated with mortality (_adjHR 3.11, 95% CI 1.95-4.94), along with increased Society of Thoracic Surgeons' score (_adjHR 1.07, 95% CI 1.03-1.12), chronic pulmonary disease (_adjHR 1.45, 95% CI 1.00-2.09), previous atrial fibrillation (_adjHR 2.11, 95% CI 1.52-2.93) and shock during the index hospitalization (_adjHR 2.56, 95% CI 1.41-4.65).

Conclusions: Readmission for heart failure occurs in one in 10 patients after successful TAVI, and is a strong risk factor for mortality. Co-morbidities and left ventricular ejection fraction after TAVI≤35% are the main risk factors for readmission for heart failure.

Keywords: Atrial fibrillation; Fibrillation auriculaire; Heart failure; Insuffisance cardiaque; Readmission; Remplacement valvulaire aortique percutané; Réadmission; Transcatheter aortic valve implantation.

Publication types

Multicenter Study

MeSH terms

Aged
Aged, 80 and over
Aortic Valve Stenosis / diagnosis
Aortic Valve Stenosis / mortality
Aortic Valve Stenosis / physiopathology
Aortic Valve Stenosis / surgery*
Comorbidity
Female
France / epidemiology
Heart Failure / diagnosis
Heart Failure / mortality
Heart Failure / physiopathology
Heart Failure / therapy*
Hospitals, High-Volume
Humans
Incidence
Male
Patient Readmission*
Prospective Studies
Risk Assessment
Risk Factors
Stroke Volume
Time Factors
Transcatheter Aortic Valve Replacement* / adverse effects
Transcatheter Aortic Valve Replacement* / mortality
Treatment Outcome
Ventricular Function, Left