Author + information
- Received April 19, 2019
- Revision received May 28, 2019
- Accepted June 11, 2019
- Published online November 4, 2019.
- Amgad Mentias, MD, MSca@AmgadMentias,
- Marwan Saad, MD, PhDb,
- Saket Girotra, MDa,
- Milind Desai, MDc,
- Ayman Elbadawi, MDd,
- Alexandros Briasoulis, MDa,
- Paulino Alvarez, MDa,
- Musab Alqasrawi, MDa,
- Michael Giudici, MDa,
- Sidakpal Panaich, MDa,
- Phillip A. Horwitz, MDa,
- Hani Jneid, MDe,
- Samir Kapadia, MDc and
- Mary Vaughan Sarrazin, PhDa,f,∗ ()
- aDepartment of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
- bDivision of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- cHeart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
- dDivision of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas
- eDivision of Cardiology, Baylor College of Medicine, Houston, Texas
- fComprehensive Access and Delivery Research and Evaluation Center, Iowa City VA Medical Center, Iowa City, Iowa
- ↵∗Address for correspondence:
Dr. Mary S. Vaughan Sarrazin, University of Iowa Institute for Clinical and Translational Sciences, 200 Hawkins Drive, C44-GH, Iowa City, Iowa 52242.
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.
This study is supported by funding from the National Institute on Aging (R01AG055663-01), and by the Health Services Research and Development Service of the Department of Veterans Affairs. Dr. Girotra is supported by grant #K08HL122527 from the National Heart, Lung, and Blood Institute at the National Institutes of Health. Dr. Horwitz has received grant support from Edwards Lifesciences and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 19, 2019.
- Revision received May 28, 2019.
- Accepted June 11, 2019.
- 2019 American College of Cardiology Foundation
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