Chronic Conditions and Patient-Centered Outcomes After Transcatheter Aortic Valve Intervention.
BACKGROUND: Transcatheter aortic valve intervention (TAVI) has revolutionized the care of older adults with aortic stenosis. OBJECTIVES: The objectives of the study were to examine associations between chronic conditions and outcomes after TAVI and to describe palliative care utilization rates. METHODS: This cohort study used the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy registry to identify patients who underwent TAVI and were eligible for linkage with Centers for Medicare & Medicaid Services claims data. The exposure was multiple chronic conditions (MCCs) in the year before TAVI. Associations between chronic conditions and outcomes were assessed using multivariable logistic regression. RESULTS: A total of 188,629 TAVI procedures were linked to Centers for Medicare & Medicaid Services claims. The median (IQR) age was 82.0 (76.0-87.0) years; 86,841 (46%) were female. Chronic conditions were associated with worse 1-year mortality (high MCC [≥6 conditions] vs low MCC [<4 chronic conditions], adjusted HR: 2.33 [95% CI: 2.22-2.44]). Chronic conditions were associated with lower Kansas City Cardiomyopathy Questionnaire at baseline (high MCC median score 37.5 [21.4-56.8] vs low MCC median score 55.7 [37.5-75.0], P < 0.001); however, the average improvement in Kansas City Cardiomyopathy Questionnaire after TAVI was large and appeared independent of chronic disease burden (median score change high MCC 28.7 [9.9-48.4] vs low MCC 24.5 [8.3-42.2], standardized difference +13.8%). Palliative care encounters were rare (8,946, 4.7%) and varied significantly across centers (range 0% to 25% of cases). CONCLUSIONS: Chronic conditions are associated with worse survival after TAVI. However, most patients with high MCC are alive 1 year after treatment, and quality of life improvements appear independent of chronic disease burden. These data help clarify expected health gains for patients with chronic conditions and symptomatic aortic stenosis.
