TAVR Improves Quality of Life, Reduces Hospitalization in German Registry

MUNICH, Germany—Transcatheter aortic valve replacement (TAVR) substantially improves quality of life and lowers subsequent hospital resource use in patients with severe aortic stenosis at high surgical risk, according to results from 2 separate presentations on August 28, 2012, at the European Society of Cardiology (ESC) Congress.

Quality of Life Better For All But the Sickest

Till Neumann, MD, of the Universitätsklinikum Essen (Essen, Germany), and colleagues collected data from the German TAVI Registry, later named the German Aortic Valve RegistrY (GARY), on 415 patients who had severe aortic stenosis and were at high risk for surgery. The patients, slightly more than a third of who were male, underwent TAVR at 30 centers in Germany between 2009 and 2011. Average age was 82 years.

Using the EQ-5D health status survey, investigators assessed quality of life before TAVR and at 30 days and 1 year after the procedure. The proportion of patients without impairment in quality of life increased over time, at least doubling in the categories of mobility, usual activity, and pain/discomfort. Likewise, the rate of patients with some problems decreased over time. However, the proportion of patients with extreme impairment stayed relatively stable (table 1).

Table 1. EQ-5D QoL Survey Results

On the EQ-5D visual analysis scale, quality of life increased from 44.7% at baseline to 65.1% at 1 year. Also, there were no differences in quality of life when patients were split into subsets including age, gender, and diabetic status.

Dr. Neumann noted that the gains in quality of life were “particularly evident after 30-day follow-up and were maintained for at least 1 year.”

When asked about optimal patient selection for TAVR, he suggested that those who are severely impaired might not be good candidates for the procedure as it is not likely for their quality of life to improve drastically, if at all.

Resources Drastically Reduced

From the same German registry, Dr. Neumann presented a second data set on resource use after TAVR. In the year before undergoing TAVR, patients averaged 2.2 ± 1.4 annual inpatient hospital stays, including 2.0 ± 1.2 stays related to cardiovascular issues. In the first year after TAVR, the overall number fell to 0.5 stays (table 2).

Table 2. Hospital Admissions 1 Year Before and After TAVR

 
At 1 year, it was estimated that 70% of patients were free of hospital admission, and there was no difference between men and women.

“Among patients from the German Transcatheter Aortic Valve Interventions Registry with severe aortic stenosis, [TAVR] resulted in meaningful reductions in resource use regarding inpatient hospital stays one year after [TAVR],” Dr. Neumann said.

Still, further research is needed to evaluate the economic effects of TAVR, “including outpatient contacts and evaluation of the economic burden of aortic stenosis,” he concluded, noting that additional information is expected to be presented on the TAVR subset of the new GARY registry at ESC 2013.

 

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Sources:
1. Neumann T. The impact of transcatheter aortic valve implantation on quality of life: Results from the German transcatheter aortic valve interventions registry. Presented at: European Society of Cardiology Congress; August 28, 2012; Munich, Germany.

2. Neumann T. The impact of transcatheter aortic valve implantation on resource use: Results from the German transcatheter aortic valve interventions registry. Presented at: European Society of Cardiology Congress; August 28, 2012; Munich, Germany.

 

 

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