What is the clinical evidence from this study?

Study design: Observational. Population: Aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) (n=63630). Intervention: Age ≥80 years vs. Age <80 years. Primary outcome: In-hospital mortality (aOR 1.56, 95% CI 1.13-2.16, p=0.006).

April 27, 2022Open Access

Comparison of In-Hospital Mortality and Clinical Outcomes Between Patients Aged More Than and Less Than 80 Years Undergoing Transcatheter Aortic Valve Replacement

Q: What are the key findings of this study?

Patients aged ≥80 years undergoing transcatheter aortic valve replacement had a significantly higher rate of in-hospital mortality compared to those <80 years old (1.6% vs. 1.1%, aOR 1.56).

Key Result

Patients aged ≥80 years undergoing transcatheter aortic valve replacement had a significantly higher rate of in-hospital mortality compared to those <80 years old (1.6% vs. 1.1%, aOR 1.56).

Study Design

Type

Observational (n=63,630)

Multicenter

Yes

PICO

Population

63,630 adult patients who underwent transcatheter aortic valve replacement in the United States during 2018, evaluated for in-hospital outcomes.

Exposure / Comparator

Age ≥80 years vs Age <80 years

Primary Outcome

In-hospital mortality — aOR 1.56 (1.13-2.16), p=0.006

Main Result

Odds Ratio: 1.56 (95% CI 1.13–2.16)

Absolute Event Rate: 1.6% vs 1.1%

p-value: p=0.006

Limitations

Retrospective study design using an administrative database is subject to coding errors and biases.
Inherent design of the National Inpatient Sample precludes long-term follow-up of outcomes.
Unavailability of laboratory and pharmacological data prevented comparison with STS and EUROSCORE risk models.
Lack of information regarding the severity of diagnoses (e.g., NYHA stage of heart failure) at the time of admission.

Abstract

Background The transcatheter aortic valve replacement (TAVR) procedure has been increasingly utilized in the management of aortic stenosis among the elderly. In this study, we sought to assess the hospital outcomes and major adverse events (MAEs) associated with TAVR in patients aged ≥80 years compared to those aged <80 years. Methodology We performed a retrospective observational study using the National Inpatient Sample in 2018. We divided TAVR patients into two cohorts based on age, namely, ≥80 years old and <80 years old. The primary outcomes included the comparison of in-hospital mortality and MAEs in the two cohorts. Results We identified 63,630 patients who underwent TAVR from January 1 to December 31, 2018. Among them, 35,115 (55%) were ≥80 years and 28,515 (45%) were <80 years of age. There was a higher rate of post-procedural in-hospital mortality in patients ≥80 years old (1.6% vs. 1.1%, adjusted odds ratio (aOR) = 1.56, confidence interval (CI) = 1.13-2.16, p = 0.006). They also had higher rates of pacemaker insertion compared to those <80 years old (7.4% vs. 6.5%, aOR = 1.17 CI = 1-1.35, p = 0.03). On subgroup analysis, the rates of MAEs were not different between the two cohorts (23.8% vs. 23.4%, p = 0.09); however, patients aged ≥80 years who experienced MAEs had higher in-hospital mortality (5.7% vs. 4.3%, aOR = 1.58 CI = 1.08-2.32, p = 0.01) and shorter length of hospital stay (7.2 vs. 8.7 days, p = 0.03) compared to those aged <80 years. Anemia, liver disease, chronic kidney disease, and previous stroke were associated with higher odds of in-hospital MAEs in both groups. Conclusions The results of our study show that patients older than 80 years of age undergoing TAVR had higher rates of in-hospital mortality and pacemaker insertion compared to those less than 80 years of age. The rates of MAEs were not significantly different between the two groups.

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