Howard C. Herrmann, MD reviewing Arnold SV et al. JAMA Cardiol 2017 Feb 1.
A large database study confirms an improved quality of life for most patients at 1 year but poor outcomes in a substantial minority.

Large randomized trials have demonstrated improvements in survival and quality of life (QOL) in patients with severe symptomatic aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). Now, investigators have sought to examine QOL at 1 year in a large real-world population drawn from the Society of Thoracic Surgeons and the American College of Cardiology's Transcatheter Valve Therapy (TVT) Registry of U.S. clinical (nonresearch) TAVR patients.

QOL data were based on patients' responses to the Kansas City Cardiomyopathy Questionnaire; its summary scores range from 0 to 100, with higher scores indicating less symptom burden and better QOL. Baseline summary scores were available for 45,564 patients from >400 sites (mean score, 40).

In 31,663 surviving patients at 30 days with analyzable data, mean score improved by 28 points (baseline, 42; 30 days, 70). In 7014 surviving patients at 1 year, scores improved further, to 76 from a baseline of 44. A poor outcome, however, occurred in 38% of patients at 1 year owing to death (19%), persistently poor QOL (scores <50; 17%), or declining QOL (5%). Predictors of worse 1-year health status included older age, severe lung disease, worse baseline health status, prior stroke, and nonfemoral access.

CITATION(S):

Arnold SV et al. Quality-of-life outcomes after transcatheter aortic valve replacement in an unselected population: A report from the STS/ACC Transcatheter Valve Therapy Registry. JAMA Cardiol 2017 Feb 1; [e-pub].

JWatch