Key result
Late TAVR shows no difference in in-hospital mortality versus early TAVR in acute heart failure.
Why the study?
Data comparing clinical outcomes of early (<48 hours) versus late (≥48 hours) TAVR in patients hospitalized with acute heart failure and aortic stenosis remain limited.
Does early TAVR (<48 hours) improve clinical outcomes compared to late TAVR (≥48 hours) in patients hospitalized with acute heart failure and aortic stenosis?
Cohort (n=25,285)
Yes
Does early TAVR (<48 hours) improve clinical outcomes compared to late TAVR (≥48 hours) in patients hospitalized with acute heart failure and aortic stenosis?
Odds Ratio: 1.01 (95% CI 1–1.02)
p-value: p=0.14
In patients hospitalized with acute heart failure and aortic stenosis, early TAVR (<48 hours) showed no difference in in-hospital mortality, cardiac arrest, or stroke compared to late TAVR, though late TAVR was associated with less need for mechanical circulatory support but higher odds of septic shock.
No mortality difference by TAVR timing in acute HF; observational data leave optimal strategy unresolved.
Introduction: Data on clinical outcomes of early transcatheter aortic valve replacement (TAVR) (<48 hours) compared to late (≥48 hours) TAVR in patients hospitalized with acute heart failure (AHF) and aortic stenosis (AS) remains limited. We aim to evaluate the differences between early vs. late TAVR regarding major clinical outcomes using a real-world US database. Hypothesis: There is no differences in the clinical outcomes based on the timing of TAVR procedural intervention in patients with acute heart failure. Methods: We used the National Inpatient Sample database by utilizing ICD-10 codes to identify all hospitalizations with a diagnosis of AHF and TAVR (2015-2020). The associations between the time of TAVR and outcomes were examined using multivariable logistic regression. Propensity-score matched (PSM) analysis was utilized to determine the adjusted odds ratio (aOR) of major clinical outcomes. Results: A total of 25,285 weighted hospitalizations of AHF were identified, of which 6,855 patients (27.1%) underwent early TAVR and 18,430 (72.9%) had late TAVR. Compared with early TAVR, Late TAVR was associated with less need for mechanical circulatory support (MCS) (aOR 0.97 [0.96-0.98], p<0.01) and acute hypoxic respiratory failure (aOR 0.99 [0.98-0.99], p<0.01), but higher odds of developing septic shock (aOR 2.06 [1.52-2.80], p <0.01). However, there was no significant difference between both procedures regarding in-hospital mortality (aOR 1.01 [1.00-1.02], p=0.14), cardiac arrest (aOR 0.99 [0.98-1.00], p=0.21), and stroke (aOR 1.01 [1.00-1.02], p=0.18). Conclusions: Most patients with AHF and AS undergo TAVR after 48 hours of their presentation. After PSM, there was no difference in inpatient mortality, cardiac arrest, and stroke between both procedures. Late TAVR was associated with lower odds for MCS and acute hypoxic respiratory failure. The optimal timing of TAVR in patients with AHF and AS needs further study.
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Hashem et al. (2023) conducted a cohort in Acute heart failure and aortic stenosis (n=25,285). Late TAVR (≥48 hours) vs. Early TAVR (<48 hours) was evaluated on In-hospital mortality (aOR 1.01, 95% CI 1.00-1.02, p=0.14). Late TAVR (≥48 hours) compared to early TAVR (<48 hours) in acute heart failure showed no significant difference in in-hospital mortality (aOR 1.01; 95% CI 1.00-1.02; p=0.14).
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