Incidence of, risk factors for and impact of readmission for heart failure after successful transcatheter aortic valve implantation.

BACKGROUND

The incidence of and risk factors for readmission for heart failure after successful transcatheter aortic valve implantation (TAVI) are unclear.

AIMS

We sought to evaluate the incidence of, risk factors for and clinical impact of readmission for heart failure after successful TAVI in an unselected patient population.

METHODS

All patients who underwent successful TAVI in two high-volume French tertiary centres from February 2010 to December 2016 were included prospectively and followed up for 1 year. A Cox multivariable model was used to assess risk factors for readmission for heart failure and mortality.

RESULTS

A total of 1139 patients (mean age 82.4±7.7years; 52.2% male sex) were included. Readmission for heart failure occurred in 99 (9.2%) patients. Risk factors for readmission for heart failure were previous atrial fibrillation (adjusted hazard ratio [HR] 1.62, 95% confidence interval [CI] 1.09-2.40), diabetes mellitus (HR 1.67, 95% CI 1.11-2.50), chronic kidney disease (HR 1.72, 95% CI 1.13-2.62), chronic pulmonary disease (HR 1.81, 95% CI 1.17-2.81) and left ventricular ejection fraction after TAVI ≤ 35% (HR 2.12, 95% CI 1.20-3.75). Readmission for heart failure was strongly associated with mortality (HR 3.11, 95% CI 1.95-4.94), along with increased Society of Thoracic Surgeons' score (HR 1.07, 95% CI 1.03-1.12), chronic pulmonary disease (HR 1.45, 95% CI 1.00-2.09), previous atrial fibrillation (HR 2.11, 95% CI 1.52-2.93) and shock during the index hospitalization (HR 2.56, 95% CI 1.41-4.65).

CONCLUSIONS

Readmission for heart failure occurs in one in 10 patients after successful TAVI, and is a strong risk factor for mortality. Co-morbidities and left ventricular ejection fraction after TAVI≤35% are the main risk factors for readmission for heart failure.