Health benefits of TAVR extend beyond the trial setting
medwireNews: Study results suggest that the health status benefits of transcatheter aortic valve replacement (TAVR) that have been observed in clinical trials extend to real-world clinical practice.
“We found that most patients had substantial impairment in health status before TAVR and demonstrated considerable improvement after the procedure,” say study author Suzanne Arnold (University of Missouri–Kansas City, USA) and colleagues.
The researchers analyzed data on short- and long-term outcomes of unselected patients with severe aortic stenosis who underwent TAVR at more than 450 clinical sites using the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (TVT) Registry.
As reported in JAMA Cardiology, they found that among 31,636 surviving patients with a median age of 83 years, the mean Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS) score improved from 42.3 at baseline to 69.9 at 30-day follow up, indicating a 27.6 point improvement in health-related quality of life.
And at 1-year follow-up, the score improved by a mean of 31.9 points to 75.9 points among 7014 surviving patients with a median age of 84 years.
“This improvement at 1 year was even larger than that reported in pivotal trials (range, 19–27.4 points), perhaps suggesting better real-world patient selection informed by prior trial experience,” writes Karen Alexander (Duke University, Durham, North Carolina, USA) in an accompanying commentary.
When the researchers integrated survival and health-related quality of life, they found that 62.3% of patients had a favorable outcome at 1 year after TAVR, defined as alive with reasonable quality of life (KCCQ-OS score of ≥60) and no significant decline (<10 points) from baseline.
Patients with severe lung disease, end-stage renal disease, and those with very poor baseline health status experienced the lowest rates of favorable outcomes, at 51.4%, 47.7%, and 49.2%, respectively.
In light of these findings, Alexander notes that “consideration of comorbid combinations at the patient level” is needed to improve identification of patients who are most likely to benefit from TAVR.
“[A]nalyzing dyads and triads of comorbidities may help decision making by placing [aortic stenosis] in context of the individual’s multidimensional health status,” she adds.
Despite finding that “on average, patient health status improved substantially” after TAVR, the authors concede that “approximately 1 in 3 patients still had a poor outcome at 1 year after TAVR.”
“Therefore, continued efforts to optimize patient selection and refine procedural and postprocedural care to maximize health status recovery are needed to continue to improve the outcomes of these patients,” they conclude.
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