Impact of Recent Heart Failure Hospitalization on Clinical Outcomes in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement: An Analysis from the PARTNER 2 Trial and Registries

Q: What does this research mean for the field?

Recent heart failure hospitalization (≤6 months) prior to transcatheter aortic valve replacement is associated with increased 30-day and 2-year all-cause mortality, cardiovascular mortality, and infective endocarditis in patients with severe aortic stenosis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Shmuel Chen; Björn Redfors; Aaron Crowley; Ori Ben‐Yehuda; Matthew R. Summers; Rebecca T. Hahn; Wael A. Jaber; Philippe Pîbarot; Maria Alu; Katherine H. Chau; Samir Kapadia; Tamim Nazif; Torsten Vahl; Vinod H. Thourani; Susheel Kodali; Martin B. Leon

doi:10.1002/ejhf.1841

May 22, 2020European Journal of Heart Failure

Impact of Recent Heart Failure Hospitalization on Clinical Outcomes in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement: An Analysis from the PARTNER 2 Trial and Registries

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Why the study?

Heart failure hospitalization prior to TAVR is associated with increased post-procedural mortality, but its association with long-term adverse outcomes in patients with symptomatic, severe aortic stenosis undergoing TAVR needed assessment.

Does recent heart failure hospitalization prior to TAVR increase mortality in patients with severe aortic stenosis?

Structured PICO

Does recent heart failure hospitalization prior to TAVR increase mortality in patients with severe aortic stenosis?

P

Population

3988 intermediate to high or prohibitive risk patients with symptomatic, severe aortic stenosis undergoing TAVR in the PARTNER 2 trial and registries.

I

Intervention

Recent (≤6 months) heart failure hospitalization prior to TAVR

C

Comparator

No recent heart failure hospitalization prior to TAVR

O

Outcome

All-cause mortality at 30 days and 2 yearshard clinical

Implication

Recent heart failure hospitalization prior to TAVR is a significant predictor of increased short- and long-term mortality and infective endocarditis.

Abstract

AIMS: Heart failure (HF) hospitalization prior to transcatheter aortic valve replacement (TAVR) is associated with increased post-procedural mortality. We sought to assess the association between recent (≤6 months) HF hospitalization and long-term adverse outcomes in patients with symptomatic, severe aortic stenosis, undergoing TAVR in the PARTNER 2 trial and registries. METHODS AND RESULTS: Intermediate to high or even prohibitive risk patients who underwent TAVR in the PARTNER 2 trial and registries were included in the analysis. Clinical outcomes at 30 days and 2 years were compared between patients according to whether they were recently hospitalized for HF, using Kaplan-Meier event rates and study-stratified multivariable Cox proportional hazards regression models. A sensitivity analysis was conducted using propensity score matching. Of 3988 patients (99.8%) with available information on recent HF hospitalization, 1622 patients (40.7%) were hospitalized for HF symptoms during the 6 months prior to TAVR. After multivariable adjustments, recent HF hospitalization was associated with increased all-cause mortality at 30 days [adjusted hazard ratio (HR) 1.63, 95% confidence interval (CI) 1.07-2.48, P = 0.02] and 2 years (adjusted HR 1.30, 95% CI 1.13-1.49, P = 0.0003), which was driven by increased cardiovascular mortality. Infective endocarditis rate at 2 years was also higher in patients with recent HF hospitalization (adjusted HR 2.35, 95% CI 1.38-4.01, P = 0.002). These results remained consistent when propensity score matching was used. CONCLUSION: In a large cohort of patients with severe symptomatic aortic stenosis from the PARTNER 2 trial and registries, all-cause and cardiovascular mortality as well as infective endocarditis rates at 2 years were higher in patients with recent HF hospitalization.