Suzanne V Arnold1, John A Spertus2, Sreekanth Vemulapalli2, Dadi Dai2, Sean M O'Brien2, Suzanne J Baron2, Ajay J Kirtane2, Michael J Mack2, Philip Green2, Matthew R Reynolds2, John S Rumsfeld2, David J Cohen2. 1. From the Department of Medicine, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (S.V.A., J.A.S., S.J.B., D.J.C.); Department of Medicine, Duke University, Durham, NC (S.V., D.D., S.M.O.); Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital (A.J.K., P.G.); Department of Cardiovascular Disease, Baylor Scott and White Health, Plano, TX (M.J.M.); Department of Medicine, Lahey Hospital and Medical Center and Harvard Clinical Research Institute, Boston, MA (M.R.R.); and Department of Medicine, Denver VA Medical Center, CO (J.S.R.). suz.v.arnold@gmail.com. 2. From the Department of Medicine, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (S.V.A., J.A.S., S.J.B., D.J.C.); Department of Medicine, Duke University, Durham, NC (S.V., D.D., S.M.O.); Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital (A.J.K., P.G.); Department of Cardiovascular Disease, Baylor Scott and White Health, Plano, TX (M.J.M.); Department of Medicine, Lahey Hospital and Medical Center and Harvard Clinical Research Institute, Boston, MA (M.R.R.); and Department of Medicine, Denver VA Medical Center, CO (J.S.R.).
Abstract
BACKGROUND: Although transcatheter aortic valve replacement (TAVR) is an effective treatment for aortic stenosis, long-term mortality after TAVR remains high and challenging to predict. The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a health status measure, assessed directly from patients, that integrates 2 clinically relevant factors (symptoms and functional status) that may predict TAVR outcomes. METHODS AND RESULTS: Among 7769 patients from 286 sites in the Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry, we examined the association between preprocedure (baseline) patient health status, as assessed by the KCCQ, and 1-year mortality after TAVR. The KCCQ Overall Summary Score was categorized as very poor: <25, poor: 25 to 49, fair: 50 to 74, or good: ≥75. Before TAVR, health status was rated as very poor in 28%, poor in 38%, fair in 24%, and good in 10%. Patients with worse health status were more likely to be women and had more comorbidities and higher STS mortality risk scores. Compared with those with good health status before TAVR and after adjusting for a broad range of baseline covariates, patients with very poor health status had a 2-fold increased hazard of death over the first year after TAVR (adjusted hazard ratio, 2.00; 95% confidence interval, 1.58-2.54), whereas those with poor and fair health status had intermediate outcomes (adjusted hazard ratio, 1.54; 95% confidence interval, 1.22-1.95 and adjusted hazard ratio, 1.20; 95% confidence interval, 0.94-1.55, respectively). CONCLUSIONS: In a national, contemporary practice cohort, worse preprocedure patient health status, as assessed by the KCCQ, was associated with greater long-term mortality after TAVR. These results support the measurement and integration of the KCCQ into mortality risk assessments for patients considering TAVR.
BACKGROUND: Although transcatheter aortic valve replacement (TAVR) is an effective treatment for aortic stenosis, long-term mortality after TAVR remains high and challenging to predict. The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a health status measure, assessed directly from patients, that integrates 2 clinically relevant factors (symptoms and functional status) that may predict TAVR outcomes. METHODS AND RESULTS: Among 7769 patients from 286 sites in the Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry, we examined the association between preprocedure (baseline) patient health status, as assessed by the KCCQ, and 1-year mortality after TAVR. The KCCQ Overall Summary Score was categorized as very poor: <25, poor: 25 to 49, fair: 50 to 74, or good: ≥75. Before TAVR, health status was rated as very poor in 28%, poor in 38%, fair in 24%, and good in 10%. Patients with worse health status were more likely to be women and had more comorbidities and higher STS mortality risk scores. Compared with those with good health status before TAVR and after adjusting for a broad range of baseline covariates, patients with very poor health status had a 2-fold increased hazard of death over the first year after TAVR (adjusted hazard ratio, 2.00; 95% confidence interval, 1.58-2.54), whereas those with poor and fair health status had intermediate outcomes (adjusted hazard ratio, 1.54; 95% confidence interval, 1.22-1.95 and adjusted hazard ratio, 1.20; 95% confidence interval, 0.94-1.55, respectively). CONCLUSIONS: In a national, contemporary practice cohort, worse preprocedure patient health status, as assessed by the KCCQ, was associated with greater long-term mortality after TAVR. These results support the measurement and integration of the KCCQ into mortality risk assessments for patients considering TAVR.
Authors: Suzanne V Arnold; Matthew R Reynolds; Yang Lei; Elizabeth A Magnuson; Ajay J Kirtane; Susheel K Kodali; Alan Zajarias; Vinod H Thourani; Philip Green; Josep Rodés-Cabau; Nirat Beohar; Michael J Mack; Martin B Leon; David J Cohen Journal: Circulation Date: 2014-05-23 Impact factor: 29.690
Authors: John D Carroll; Fred H Edwards; Danica Marinac-Dabic; Ralph G Brindis; Frederick L Grover; Eric D Peterson; E Murat Tuzcu; David M Shahian; John S Rumsfeld; Cynthia M Shewan; Kathleen Hewitt; David R Holmes; Michael J Mack Journal: J Am Coll Cardiol Date: 2013-05-01 Impact factor: 24.094
Authors: David R Holmes; J Matthew Brennan; John S Rumsfeld; David Dai; Sean M O'Brien; Sreekanth Vemulapalli; Fred H Edwards; John Carroll; David Shahian; Fred Grover; E Murat Tuzcu; Eric D Peterson; Ralph G Brindis; Michael J Mack Journal: JAMA Date: 2015-03-10 Impact factor: 56.272
Authors: David H Adams; Jeffrey J Popma; Michael J Reardon; Steven J Yakubov; Joseph S Coselli; G Michael Deeb; Thomas G Gleason; Maurice Buchbinder; James Hermiller; Neal S Kleiman; Stan Chetcuti; John Heiser; William Merhi; George Zorn; Peter Tadros; Newell Robinson; George Petrossian; G Chad Hughes; J Kevin Harrison; John Conte; Brijeshwar Maini; Mubashir Mumtaz; Sharla Chenoweth; Jae K Oh Journal: N Engl J Med Date: 2014-03-29 Impact factor: 91.245
Authors: Gabriel E Soto; Philip Jones; William S Weintraub; Harlan M Krumholz; John A Spertus Journal: Circulation Date: 2004-07-19 Impact factor: 29.690
Authors: Paul A Heidenreich; John A Spertus; Philip G Jones; William S Weintraub; John S Rumsfeld; Saif S Rathore; Eric D Peterson; Frederick A Masoudi; Harlan M Krumholz; Edward P Havranek; Mark W Conard; Randall E Williams Journal: J Am Coll Cardiol Date: 2006-01-26 Impact factor: 24.094
Authors: Philip Green; David J Cohen; Philippe Généreux; Tom McAndrew; Suzanne V Arnold; Maria Alu; Nirat Beohar; Charanjit S Rihal; Michael J Mack; Samir Kapadia; Danny Dvir; Mathew S Maurer; Mathew R Williams; Susheel Kodali; Martin B Leon; Ajay J Kirtane Journal: Am J Cardiol Date: 2013-05-29 Impact factor: 2.778
Authors: Suzanne V Arnold; John A Spertus; Sreekanth Vemulapalli; Zhuokai Li; Roland A Matsouaka; Suzanne J Baron; Amit N Vora; Michael J Mack; Matthew R Reynolds; John S Rumsfeld; David J Cohen Journal: JAMA Cardiol Date: 2017-04-01 Impact factor: 14.676
Authors: Jacob V Spertus; Laura A Hatfield; David J Cohen; Suzanne V Arnold; Martin Ho; Philip G Jones; Martin Leon; Bram Zuckerman; John A Spertus Journal: Circ Cardiovasc Qual Outcomes Date: 2019-06-13
Authors: Yashashwi Pokharel; Yevgeniy Khariton; Yuanyuan Tang; Michael E Nassif; Paul S Chan; Suzanne V Arnold; Philip G Jones; John A Spertus Journal: JAMA Cardiol Date: 2017-12-01 Impact factor: 14.676
Authors: Suzanne V Arnold; Sean M O'Brien; Sreekanth Vemulapalli; David J Cohen; Amanda Stebbins; J Matthew Brennan; David M Shahian; Fred L Grover; David R Holmes; Vinod H Thourani; Eric D Peterson; Fred H Edwards Journal: JACC Cardiovasc Interv Date: 2018-03-26 Impact factor: 11.195
Authors: Kjersti Oterhals; Rune Haaverstad; Jan Erik Nordrehaug; Geir Egil Eide; Tone M Norekvål Journal: BMJ Open Date: 2017-08-21 Impact factor: 2.692
Authors: Vittal Hejjaji; David J Cohen; John D Carroll; Zhuokai Li; Pratik Manandhar; Sreekanth Vemulapalli; Adam J Nelson; Ali O Malik; Michael J Mack; John A Spertus; Suzanne V Arnold Journal: Circ Cardiovasc Qual Outcomes Date: 2021-02-18
Authors: Nariman Sepehrvand; Anamaria Savu; John A Spertus; Jason R B Dyck; Todd Anderson; Jonathan Howlett; Ian Paterson; Gavin Y Oudit; Padma Kaul; Finlay A McAlister; Justin A Ezekowitz Journal: J Am Heart Assoc Date: 2020-08-19 Impact factor: 5.501
Authors: Maria Zisiopoulou; Alexander Berkowitsch; Philipp Seppelt; Andreas M Zeiher; Mariuca Vasa-Nicotera Journal: Medicina (Kaunas) Date: 2021-12-06 Impact factor: 2.430
Authors: Javed Butler; John A Spertus; Luke Bamber; Muhammad Shahzeb Khan; Lothar Roessig; Vanja Vlajnic; Josephine M Norquist; Kevin J Anstrom; Robert O Blaustein; Carolyn S P Lam; Paul W Armstrong Journal: Eur J Heart Fail Date: 2022-04-03 Impact factor: 17.349