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dc.contributor.authorFeldman, Daniel R
dc.contributor.authorRomashko, Mikhail D
dc.contributor.authorKoethe, Benjamin
dc.contributor.authorPatel, Sonika
dc.contributor.authorRastegar, Hassan
dc.contributor.authorZhan, Yong
dc.contributor.authorResor, Charles D
dc.contributor.authorConnors, Annie C
dc.contributor.authorKimmelstiel, Carey
dc.contributor.authorAllen, David
dc.contributor.authorWeintraub, Andrew R
dc.contributor.authorWessler, Benjamin S
dc.date.accessioned2021-05-11T20:07:31Z
dc.date.available2021-05-11T20:07:31Z
dc.date.issued2021-05-07
dc.identifier.urihttp://hdl.handle.net/10713/15619
dc.description.abstractBackground Transcatheter aortic valve replacement (TAVR) has become the preferred treatment for symptomatic patients with aortic stenosis and elevated procedural risk. Many deaths following TAVR are because of noncardiac causes and comorbid disease burden may be a major determinant of postprocedure outcomes. The prevalence of comorbid conditions and associations with outcomes after TAVR has not been studied. Methods and Results This was a retrospective single-center study of patients treated with TAVR from January 2015 to October 2018. The association between 21 chronic conditions and short- and medium-term outcomes was assessed. A total of 341 patients underwent TAVR and had 1-year follow-up. The mean age was 81.4 (SD 8.0) years with a mean Society of Thoracic Surgeons predicted risk of mortality score of 6.7% (SD 4.8). Two hundred twenty (65%) patients had ≥4 chronic conditions present at the time of TAVR. There was modest correlation between Society of Thoracic Surgeons predicted risk of mortality and comorbid disease burden (r=0.32, P<0.001). After adjusting for Society of Thoracic Surgeons predicted risk of mortality, age, and vascular access, each additional comorbid condition was associated with increased rates of 30-day rehospitalizations (odds ratio, 1.21; 95% CI, 1.02-1.44), a composite of 30-day rehospitalization and 30-day mortality (odds ratio, 1.20; 95% CI, 1.02-1.42), and 1-year mortality (odds ratio, 1.29; 95% CI, 1.05-1.59). Conclusions Comorbid disease burden is associated with worse clinical outcomes in high-risk patients treated with TAVR. The risks associated with comorbid disease burden are not adequately captured by standard risk assessment. A systematic assessment of comorbid conditions may improve risk stratification efforts.en_US
dc.description.urihttps://doi.org/10.1161/JAHA.120.018978en_US
dc.language.isoenen_US
dc.publisherAmerican Heart Associationen_US
dc.relation.ispartofJournal of the American Heart Associationen_US
dc.subjectcardiac diseaseen_US
dc.subjectcardiovascular disease risk factorsen_US
dc.subjectclinical cardiologyen_US
dc.subjecttranscatheter aortic valve implantationen_US
dc.titleComorbidity Burden and Adverse Outcomes After Transcatheter Aortic Valve Replacement.en_US
dc.typeArticleen_US
dc.identifier.doi10.1161/JAHA.120.018978
dc.identifier.pmid33960198
dc.source.beginpagee018978
dc.source.endpage
dc.source.countryEngland


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