Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark.
Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark; The Danish Heart Foundation, Copenhagen, Denmark.
JACC Cardiovasc Interv. 2023 Jan 23;16(2):179-188. doi: 10.1016/j.jcin.2022.10.051.
Loss of autonomy associated with nursing home admission (NHA) is a concern for patients. Yet the incidence of NHA after transcatheter aortic valve replacement (TAVR) is unknown.
The aim of this study was to investigate the incidence and factors associated with NHA following TAVR compared with the general population.
Through Danish registries, patients alive at discharge after TAVR were identified from January 2014 to October 2021. Patients were matched 1:5 on sex, age, and calendar year to the general population. The 3-year cumulative incidence and 95% CI of NHA were estimated using the Aalen-Johansen estimator, accounting for the competing risk for death. Through multivariate cause-specific Cox regression models, factors associated with NHA were examined.
In total, 5,312 TAVR patients were matched to 26,560 control subjects with a median age of 81 years and 56.1% males. Comorbidity burden was higher for TAVR patients. The 3-year cumulative incidence of NHA was 6.3% (95% CI: 5.5%-7.1%) for TAVR patients compared with 5.8% (95% CI: 5.4%-6.1%) for the general population. For TAVR patients >85 years of age, the cumulative incidence of NHA was 11.6% (95% CI: 9.5%-13.8%), and the risk for death was 23.3% (95% CI: 20.4%-26.2%). Factors associated with NHA were increasing age, frailty, living alone, and atrial fibrillation.
TAVR was not associated with an increased incidence of NHA compared with the general population. Despite the increased incidence of NHA for TAVR patients >85 years of age, approximately 2 in 3 patients were still alive and not admitted to nursing homes 3 years after TAVR.
与入住养老院（NHA）相关的自主性丧失是患者关注的问题。然而，经导管主动脉瓣置换术（TAVR）后 NHA 的发生率尚不清楚。
本研究旨在调查 TAVR 后与普通人群相比，NHA 的发生率和相关因素。
通过丹麦登记处，确定了 2014 年 1 月至 2021 年 10 月 TAVR 出院时存活的患者。根据性别、年龄和日历年份，患者与普通人群 1:5 匹配。使用 Aalen-Johansen 估计器估计 3 年累积发病率和 95%置信区间（CI），同时考虑死亡的竞争风险。通过多变量特定原因 Cox 回归模型，研究了与 NHA 相关的因素。
共有 5312 名 TAVR 患者与 26560 名对照患者相匹配，中位年龄为 81 岁，男性占 56.1%。TAVR 患者的合并症负担更高。TAVR 患者的 3 年累积 NHA 发生率为 6.3%（95%CI：5.5%-7.1%），而普通人群为 5.8%（95%CI：5.4%-6.1%）。对于>85 岁的 TAVR 患者，NHA 的累积发生率为 11.6%（95%CI：9.5%-13.8%），死亡风险为 23.3%（95%CI：20.4%-26.2%）。与 NHA 相关的因素包括年龄增长、虚弱、独居和心房颤动。
与普通人群相比，TAVR 并不增加 NHA 的发生率。尽管 TAVR 患者>85 岁的 NHA 发生率增加，但大约 2/3 的患者在 TAVR 后 3 年仍存活且未入住养老院。
