Amgad Mentias1, Marwan Saad2, Saket Girotra3, Milind Desai4, Ayman Elbadawi5, Alexandros Briasoulis3, Paulino Alvarez3, Musab Alqasrawi3, Michael Giudici3, Sidakpal Panaich3, Phillip A Horwitz3, Hani Jneid6, Samir Kapadia4, Mary Vaughan Sarrazin7. 1. Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa. Electronic address: https://twitter.com/AmgadMentias. 2. Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas. 3. Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa. 4. Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio. 5. Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas. 6. Division of Cardiology, Baylor College of Medicine, Houston, Texas. 7. Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa; Comprehensive Access and Delivery Research and Evaluation Center, Iowa City VA Medical Center, Iowa City, Iowa. Electronic address: mary-vaughan-sarrazin@uiowa.edu.
Abstract
OBJECTIVES: This study sought to evaluate impact of new-onset and pre-existing atrial fibrillation (AF) on transcatheter aortic valve replacement (TAVR) long-term outcomes compared with patients without AF. BACKGROUND: Pre-existing and new-onset AF in patients undergoing TAVR are associated with poor outcomes. METHODS: The study identified 72,660 patients ≥65 years of age who underwent nonapical TAVR between 2014 and 2016 using Medicare inpatient claims. History of AF was defined by diagnoses on claims during the 3 years preceding the TAVR, and new-onset AF was defined as occurrence of AF during the TAVR admission or within 30 days after TAVR in a patient without prior history of AF. Outcomes included all-cause mortality, and readmission for bleeding, stroke, and heart failure (HF). RESULTS: Overall, 40.7% had pre-existing AF (n = 29,563) and 6.8% experienced new-onset AF (n = 2,948) after TAVR. Mean age was 81.3, 82.4, and 83.8 years in patients with no AF, pre-existing, and new-onset AF, respectively. Pre-existing AF patients had the highest burden of comorbidities. After follow-up of 73,732 person-years, mortality was higher with new-onset AF compared with pre-existing and no AF (29.7, 22.6, and 12.8 per 100 person-years, respectively; p < 0.001). After adjusting for patient characteristics and hospital TAVR volume, new-onset AF remained associated with higher mortality compared with no AF (adjusted hazard ratio: 2.068, 95% confidence interval [CI]: 1.92 to 2.20; p < 0.01) and pre-existing AF (adjusted hazard ratio: 1.35; 95% CI: 1.26 to 1.45; p < 0.01). In competing risk analysis, new-onset AF was associated with higher risk of bleeding (subdistribution hazard ratio [sHR]: 1.66; 95% CI: 1.48 to 1.86; p < 0.01), stroke (sHR: 1.92; 95% CI: 1.63 to 2.26; p < 0.01), and HF (sHR: 1.98; 95% CI: 1.81 to 2.16; p < 0.01) compared with pre-existing AF. CONCLUSIONS: In patients undergoing TAVR, new-onset AF is associated with increased risk of mortality and bleeding, stroke, and HF hospitalizations compared with pre-existing AF or no AF.
OBJECTIVES: This study sought to evaluate impact of new-onset and pre-existing atrial fibrillation (AF) on transcatheter aortic valve replacement (TAVR) long-term outcomes compared with patients without AF. BACKGROUND: Pre-existing and new-onset AF in patients undergoing TAVR are associated with poor outcomes. METHODS: The study identified 72,660 patients ≥65 years of age who underwent nonapical TAVR between 2014 and 2016 using Medicare inpatient claims. History of AF was defined by diagnoses on claims during the 3 years preceding the TAVR, and new-onset AF was defined as occurrence of AF during the TAVR admission or within 30 days after TAVR in a patient without prior history of AF. Outcomes included all-cause mortality, and readmission for bleeding, stroke, and heart failure (HF). RESULTS: Overall, 40.7% had pre-existing AF (n = 29,563) and 6.8% experienced new-onset AF (n = 2,948) after TAVR. Mean age was 81.3, 82.4, and 83.8 years in patients with no AF, pre-existing, and new-onset AF, respectively. Pre-existing AFpatients had the highest burden of comorbidities. After follow-up of 73,732 person-years, mortality was higher with new-onset AF compared with pre-existing and no AF (29.7, 22.6, and 12.8 per 100 person-years, respectively; p < 0.001). After adjusting for patient characteristics and hospital TAVR volume, new-onset AF remained associated with higher mortality compared with no AF (adjusted hazard ratio: 2.068, 95% confidence interval [CI]: 1.92 to 2.20; p < 0.01) and pre-existing AF (adjusted hazard ratio: 1.35; 95% CI: 1.26 to 1.45; p < 0.01). In competing risk analysis, new-onset AF was associated with higher risk of bleeding (subdistribution hazard ratio [sHR]: 1.66; 95% CI: 1.48 to 1.86; p < 0.01), stroke (sHR: 1.92; 95% CI: 1.63 to 2.26; p < 0.01), and HF (sHR: 1.98; 95% CI: 1.81 to 2.16; p < 0.01) compared with pre-existing AF. CONCLUSIONS: In patients undergoing TAVR, new-onset AF is associated with increased risk of mortality and bleeding, stroke, and HF hospitalizations compared with pre-existing AF or no AF.
Authors: Amanda Jia Qi Ooi; Chloe Wong; Timothy Wei Ern Tan; Trina Priscilla Ng; Yao Neng Teo; Yao Hao Teo; Nicholas L Syn; Andie H Djohan; Yinghao Lim; Leonard L L Yeo; Benjamin Y Q Tan; Mark Yan-Yee Chan; Kian-Keong Poh; William K F Kong; Ping Chai; Tiong-Cheng Yeo; James W Yip; Ivandito Kuntjoro; Ching-Hui Sia Journal: Eur J Clin Pharmacol Date: 2022-08-09 Impact factor: 3.064
Authors: Ahmed Sayed; Salma Almotawally; Karim Wilson; Malak Munir; Ahmed Bendary; Ahmed Ramzy; Sameer Hirji; Abdelrahman Ibrahim Abushouk Journal: Open Heart Date: 2021-01
Authors: Hyung Ki Jeong; Namsik Yoon; Ju Han Kim; Nuri Lee; Dae Yong Hyun; Min Chul Kim; Ki Hong Lee; Yo Cheon Jeong; In Seok Jeong; Hyun Ju Yoon; Kye Hun Kim; Hyung Wook Park; Youngkeun Ahn; Myung Ho Jeong; Jeong Gwan Cho Journal: Front Cardiovasc Med Date: 2021-11-29