End of Life After Transcatheter Aortic Valve Replacement: A Danish Nationwide Cohort Study

Jarl Emanuel Strange; Anders Holt; Daniel Mølager Christensen; Nina Nouhravesh; Jeppe Kofoed Petersen; Pernille Steen Bække; Ole De Backer; Morten Schou; Lars Køber; Emil Loldrup Fosbøl

doi:10.1016/j.jcin.2024.09.021

End of Life After Transcatheter Aortic Valve Replacement: A Danish Nationwide Cohort Study

Jarl Emanuel Strange
, Anders Holt
, Daniel Mølager Christensen
, Nina Nouhravesh
, Jeppe Kofoed Petersen
, Pernille Steen Bække
, Ole De Backer
, Morten Schou
, Lars Køber
, Emil Loldrup Fosbøl

Cardiology

Research output: Contribution to journal › Article › Research › peer-review

Abstract

BACKGROUND: Survival after transcatheter aortic valve replacement (TAVR) has markedly increased. Thus, other comorbidities will intersect patient trajectories and challenge follow-up.

OBJECTIVES: The aim of this study was to describe patient characteristics and hospitalizations at end of life to further improve the quality of life for patients undergoing TAVR.

METHODS: Using Danish nationwide registers, all patients who underwent TAVR were matched 1:10 at the time of death on age, sex, and calendar year of death to controls from the general population.

RESULTS: From 2008 to 2022, 2,544 TAVR patients who died were matched with 25,440 controls (median age 86 years, 55.1% males). Frailty and comorbidities were more prevalent in the TAVR group (eg, intermediate/high frailty: 2,200/2,544 [86.4%] vs 18,966/25,440 [74.6%]; heart failure: 1,407/2,544 [55.3%] vs 4,641/25,440 [18.2%]; chronic kidney disease: 633/2,544 [24.9%] vs 3,353/25,440 [13.2%]). In the last year of life, 650 of 2,544 patients (25.6%) in the TAVR group were hospitalized >28 days vs 4,160 of 25,440 (16.4%) for the controls. Of hospitalizations in the last year of life, 4,900 of 6,943 (70.6%) vs 38,833 of 49,438 (78.5%) were for a noncardiovascular cause, 1,253 of 6,943 (18.0%) vs 4,924 of 49,438 (10.0%) were cardiovascular, and 790 of 6,943 (11.4%) vs 5,681 of 49,438 (11.5%) were because of symptoms (eg, dyspnea, vomiting, or urine retention) in the TAVR group and the control group, respectively. Of cardiovascular hospitalizations, 529 of 1,253 (42.2%) vs 1,322 of 4,924 (26.8%) were because of heart failure in the TAVR group vs the controls.

CONCLUSIONS: End of life for TAVR patients is characterized by high frailty and comorbidity burden. Importantly, most hospitalizations are of noncardiovascular cause, underscoring the need for a multidisciplinary approach toward end of life for TAVR patients. Future research is needed to improve follow-up and care in this patient population.

Original language	English
Pages (from-to)	2936-2946
Number of pages	11
Journal	JACC: Cardiovascular Interventions
Volume	17
Issue number	24
DOIs	https://doi.org/10.1016/j.jcin.2024.09.021
Publication status	Published - 23 Dec 2024

Funding

Dr Christensen has received an independent research grant from the Lundbeck Foundation. Dr Nouhravesh has received unrelated speaker honoraria from Bayer and AstraZeneca. Dr Bakke has received funding from Boston Scientific, Abbott, and Medtronic not related to this manuscript. Dr De Backer has received institutional grants and consulting fees from Abbott and Boston Scientific. Dr Schou has received lecture fees from Boehringer, AstraZeneca, Novart is, and Novo Nordisk. Dr Kober has received speaker fees from AstraZeneca, Bayer, Boehringer, and Novatis. Dr Fosb & oslash;l has received an independent research grant from Novo Nordisk Foundation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Funders
Lundbeck Foundation

Keywords

Humans
Transcatheter Aortic Valve Replacement/adverse effects
Denmark/epidemiology
Male
Female
Aged, 80 and over
Registries
Time Factors
Aged
Risk Factors
Treatment Outcome
Aortic Valve Stenosis/surgery
Comorbidity
Quality of Life
Frailty/diagnosis
Risk Assessment
Aortic Valve/surgery
Frail Elderly
Hospitalization
Prevalence
Epidemiology
Hospitalizations
Mortality
End of life
Transcatheter aortic valve replacement

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10.1016/j.jcin.2024.09.021Licence: CC BY

Cite this

@article{0de3b5beda1c4887ac96e28f828f020c,

title = "End of Life After Transcatheter Aortic Valve Replacement: A Danish Nationwide Cohort Study",

abstract = "BACKGROUND: Survival after transcatheter aortic valve replacement (TAVR) has markedly increased. Thus, other comorbidities will intersect patient trajectories and challenge follow-up.OBJECTIVES: The aim of this study was to describe patient characteristics and hospitalizations at end of life to further improve the quality of life for patients undergoing TAVR.METHODS: Using Danish nationwide registers, all patients who underwent TAVR were matched 1:10 at the time of death on age, sex, and calendar year of death to controls from the general population.RESULTS: From 2008 to 2022, 2,544 TAVR patients who died were matched with 25,440 controls (median age 86 years, 55.1\% males). Frailty and comorbidities were more prevalent in the TAVR group (eg, intermediate/high frailty: 2,200/2,544 [86.4\%] vs 18,966/25,440 [74.6\%]; heart failure: 1,407/2,544 [55.3\%] vs 4,641/25,440 [18.2\%]; chronic kidney disease: 633/2,544 [24.9\%] vs 3,353/25,440 [13.2\%]). In the last year of life, 650 of 2,544 patients (25.6\%) in the TAVR group were hospitalized >28 days vs 4,160 of 25,440 (16.4\%) for the controls. Of hospitalizations in the last year of life, 4,900 of 6,943 (70.6\%) vs 38,833 of 49,438 (78.5\%) were for a noncardiovascular cause, 1,253 of 6,943 (18.0\%) vs 4,924 of 49,438 (10.0\%) were cardiovascular, and 790 of 6,943 (11.4\%) vs 5,681 of 49,438 (11.5\%) were because of symptoms (eg, dyspnea, vomiting, or urine retention) in the TAVR group and the control group, respectively. Of cardiovascular hospitalizations, 529 of 1,253 (42.2\%) vs 1,322 of 4,924 (26.8\%) were because of heart failure in the TAVR group vs the controls.CONCLUSIONS: End of life for TAVR patients is characterized by high frailty and comorbidity burden. Importantly, most hospitalizations are of noncardiovascular cause, underscoring the need for a multidisciplinary approach toward end of life for TAVR patients. Future research is needed to improve follow-up and care in this patient population.",

keywords = "Humans, Transcatheter Aortic Valve Replacement/adverse effects, Denmark/epidemiology, Male, Female, Aged, 80 and over, Registries, Time Factors, Aged, Risk Factors, Treatment Outcome, Aortic Valve Stenosis/surgery, Comorbidity, Quality of Life, Frailty/diagnosis, Risk Assessment, Aortic Valve/surgery, Frail Elderly, Hospitalization, Prevalence, Epidemiology, Hospitalizations, Mortality, End of life, Transcatheter aortic valve replacement",

author = "Strange, \{Jarl Emanuel\} and Anders Holt and Christensen, \{Daniel M{\o}lager\} and Nina Nouhravesh and Petersen, \{Jeppe Kofoed\} and B{\ae}kke, \{Pernille Steen\} and \{De Backer\}, Ole and Morten Schou and Lars K{\o}ber and Fosb{\o}l, \{Emil Loldrup\}",

year = "2024",

month = dec,

day = "23",

doi = "10.1016/j.jcin.2024.09.021",

language = "English",

volume = "17",

pages = "2936--2946",

journal = "JACC: Cardiovascular Interventions",

issn = "1936-8798",

publisher = "Elsevier",

number = "24",

}

TY - JOUR

T1 - End of Life After Transcatheter Aortic Valve Replacement

T2 - A Danish Nationwide Cohort Study

AU - Strange, Jarl Emanuel

AU - Holt, Anders

AU - Christensen, Daniel Mølager

AU - Nouhravesh, Nina

AU - Petersen, Jeppe Kofoed

AU - Bække, Pernille Steen

AU - De Backer, Ole

AU - Schou, Morten

AU - Køber, Lars

AU - Fosbøl, Emil Loldrup

PY - 2024/12/23

Y1 - 2024/12/23

N2 - BACKGROUND: Survival after transcatheter aortic valve replacement (TAVR) has markedly increased. Thus, other comorbidities will intersect patient trajectories and challenge follow-up.OBJECTIVES: The aim of this study was to describe patient characteristics and hospitalizations at end of life to further improve the quality of life for patients undergoing TAVR.METHODS: Using Danish nationwide registers, all patients who underwent TAVR were matched 1:10 at the time of death on age, sex, and calendar year of death to controls from the general population.RESULTS: From 2008 to 2022, 2,544 TAVR patients who died were matched with 25,440 controls (median age 86 years, 55.1% males). Frailty and comorbidities were more prevalent in the TAVR group (eg, intermediate/high frailty: 2,200/2,544 [86.4%] vs 18,966/25,440 [74.6%]; heart failure: 1,407/2,544 [55.3%] vs 4,641/25,440 [18.2%]; chronic kidney disease: 633/2,544 [24.9%] vs 3,353/25,440 [13.2%]). In the last year of life, 650 of 2,544 patients (25.6%) in the TAVR group were hospitalized >28 days vs 4,160 of 25,440 (16.4%) for the controls. Of hospitalizations in the last year of life, 4,900 of 6,943 (70.6%) vs 38,833 of 49,438 (78.5%) were for a noncardiovascular cause, 1,253 of 6,943 (18.0%) vs 4,924 of 49,438 (10.0%) were cardiovascular, and 790 of 6,943 (11.4%) vs 5,681 of 49,438 (11.5%) were because of symptoms (eg, dyspnea, vomiting, or urine retention) in the TAVR group and the control group, respectively. Of cardiovascular hospitalizations, 529 of 1,253 (42.2%) vs 1,322 of 4,924 (26.8%) were because of heart failure in the TAVR group vs the controls.CONCLUSIONS: End of life for TAVR patients is characterized by high frailty and comorbidity burden. Importantly, most hospitalizations are of noncardiovascular cause, underscoring the need for a multidisciplinary approach toward end of life for TAVR patients. Future research is needed to improve follow-up and care in this patient population.

AB - BACKGROUND: Survival after transcatheter aortic valve replacement (TAVR) has markedly increased. Thus, other comorbidities will intersect patient trajectories and challenge follow-up.OBJECTIVES: The aim of this study was to describe patient characteristics and hospitalizations at end of life to further improve the quality of life for patients undergoing TAVR.METHODS: Using Danish nationwide registers, all patients who underwent TAVR were matched 1:10 at the time of death on age, sex, and calendar year of death to controls from the general population.RESULTS: From 2008 to 2022, 2,544 TAVR patients who died were matched with 25,440 controls (median age 86 years, 55.1% males). Frailty and comorbidities were more prevalent in the TAVR group (eg, intermediate/high frailty: 2,200/2,544 [86.4%] vs 18,966/25,440 [74.6%]; heart failure: 1,407/2,544 [55.3%] vs 4,641/25,440 [18.2%]; chronic kidney disease: 633/2,544 [24.9%] vs 3,353/25,440 [13.2%]). In the last year of life, 650 of 2,544 patients (25.6%) in the TAVR group were hospitalized >28 days vs 4,160 of 25,440 (16.4%) for the controls. Of hospitalizations in the last year of life, 4,900 of 6,943 (70.6%) vs 38,833 of 49,438 (78.5%) were for a noncardiovascular cause, 1,253 of 6,943 (18.0%) vs 4,924 of 49,438 (10.0%) were cardiovascular, and 790 of 6,943 (11.4%) vs 5,681 of 49,438 (11.5%) were because of symptoms (eg, dyspnea, vomiting, or urine retention) in the TAVR group and the control group, respectively. Of cardiovascular hospitalizations, 529 of 1,253 (42.2%) vs 1,322 of 4,924 (26.8%) were because of heart failure in the TAVR group vs the controls.CONCLUSIONS: End of life for TAVR patients is characterized by high frailty and comorbidity burden. Importantly, most hospitalizations are of noncardiovascular cause, underscoring the need for a multidisciplinary approach toward end of life for TAVR patients. Future research is needed to improve follow-up and care in this patient population.

KW - Humans

KW - Transcatheter Aortic Valve Replacement/adverse effects

KW - Denmark/epidemiology

KW - Male

KW - Female

KW - Aged, 80 and over

KW - Registries

KW - Time Factors

KW - Aged

KW - Risk Factors

KW - Treatment Outcome

KW - Aortic Valve Stenosis/surgery

KW - Comorbidity

KW - Quality of Life

KW - Frailty/diagnosis

KW - Risk Assessment

KW - Aortic Valve/surgery

KW - Frail Elderly

KW - Hospitalization

KW - Prevalence

KW - Epidemiology

KW - Hospitalizations

KW - Mortality

KW - End of life

KW - Transcatheter aortic valve replacement

U2 - 10.1016/j.jcin.2024.09.021

DO - 10.1016/j.jcin.2024.09.021

M3 - Article

C2 - 39722275

SN - 1936-8798

VL - 17

SP - 2936

EP - 2946

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

IS - 24

ER -

End of Life After Transcatheter Aortic Valve Replacement: A Danish Nationwide Cohort Study

Abstract

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Keywords

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