Less than 20% of patients that could benefit from TAVR are receiving it

 The introduction of transcatheter aortic valve replacement procedures (TAVR) seems to have increased the number of elderly patients hospitalized with severe aortic stenosis, as well as the number of interventions. However, less than one fifth of patients over 85 are intervened, according to a Canadian registry.

 

Given the significant difference in mortality with TAVR, observed even in elderly patients, it is vital to call the attention of clinical cardiologists.

 

Using data of 37,970 patients hospitalized between 2004 and 2013 with primary or secondary aortic stenosis, repeat interventions and mortality rates were followed up at one year.

 

Hospitalization rates increased from 36 to 39% during this period (p<0.001). Similarly, intervention rates (TAVR or surgery) within 12 months after initial hospitalization, increased from 39% in 2004 to 44% in 2013 (p<0.001), with the largest increase in patients over 85 (5% to 18%; p<0.001).

 

A huge limitation to this study, is that there are no registries of echocardiographic data or symptoms, which is why we are not able to tell the number of patients that really needed a valve intervention and would not get it, but we are under the impression that it is lower than it should be.

 

Lastly, after the first hospitalization, mortality at 30 days was 12%, and at one year, 26%. These rates remained stable for the whole study period.

 

For those undergoing a valve intervention (TAVR or surgery), mortality did improve in time.

 

Original Title: Trends in the hospitalization rates and outcomes of patients with aortic stenosis from 2004 to 2013.

Presenter:  Czarnecki A.


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