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- Ikenna Erinne,
- Varun Maheshwari,
- Ravi Parikh,
- Mukta Srivastava and
- Anuj Gupta
Thirty-day readmission rates are a performance benchmark in contemporary evaluation of cardiovascular procedures. Trans-catheter aortic valve replacement (TAVR) has been widely adopted since initial Food and Drug Administration approval in 2011; however, re-admission rate following TAVR remains high. Amongst cardiac etiologies for re-admission post-TAVR, heart failure is the most common precipitant. In randomized controlled trials, spironolactone has been shown to reduce heart failure readmissions in patients with heart failure with reduced ejection fraction (HFrEF) as well as with preserved EF (HFpEF). We sought to examine the impact of spironolactone therapy on the rate of heart failure readmissions in patients discharged after TAVR at our institution.
We analyzed all TAVR patients receiving balloon-expandable Sapien (Edwards Lifesciences, Irvine, California) or self-expanding CoreValve (Medtronic, Minneapolis, Minnesota) valves from March 2012 to April 2017 at the University of Maryland Medical Center, Baltimore, MD. Patients discharged from the hospital following the TAVR procedure were grouped into two categories: those who received spironolactone (either prescribed prior to the procedure and continued upon discharge or newly initiated on spironolactone) and those who did not, based on physician discretion. The primary outcome evaluated was 30-day readmission for heart failure.
270 patients who underwent TAVR (132 Sapien, 138 CoreValve) were included for analysis. The mean age was 80.7 ± 9.5 years, 52% were men, 89% were Caucasian race, and 24% were on spironolactone at time of hospital discharge. A total of 52 (19%) patients were re-admitted within 30 days of discharge and among those, 21 (8%) were re-admissions for decompensated heart failure. Of those re-admitted to the hospital with heart failure, 9% were on spironolactone compared to 7% who were not (p=0.65).
Our retrospective analysis did not demonstrate an impact of spironolactone on the likelihood of readmission for heart failure (both HFpEF and HFrEF sub-types) following TAVR. Further prospective studies are required in order to assess clinical benefits of adding post-procedure spironolactone.