Association Between Reduction in Loop Diuretics and Heart Failure Rehospitalization After Transcatheter Aortic Valve Replacement

Background: Although transcatheter aortic valve replacement (TAVR) improves heart failure (HF) conditions for patients with severe aortic stenosis, more than 10% of patients have HF rehospitalization within 1 year. In contrast, the continuation of loop diuretics (LD) may lead to adverse outcomes in patients with HF. This study investigated the impact of LD reduction on HF rehospitalization in post-TAVR patients using a nationwide database. Methods and Results: This retrospective observational study used the National Database of Japan from 2014 to 2021. Patients undergoing first-time TAVR without worsening HF within 90 days post-procedure were included and categorized according to changes in LD dose at 90 days: No LD group; Reduced LD group; and Non-Reduced LD group. The primary outcome was HF rehospitalization within 2 years. Inverse probability of treatment weighting was performed to evaluate the association between LD dose changes and outcomes. Among 29,358 eligible patients, 19,070 were not prescribed LD, 5,596 were in the Reduced LD group, and 4,692 were in the Non-reduced LD group. Compared with the Non-reduced LD group, the Reduced LD group had a significantly lower risk of HF rehospitalization (HR 0.46; 95% confidence interval 0.41-0.51; P<0.001). Conclusions: LD reduction was associated with reduced HF rehospitalization in stable HF patients after TAVR.