Readmission and In-Hospital Outcomes After Transcatheter Aortic Valve Replacement in Patients With Dementia

Abstract

Background/purpose: The prevalence of dementia and aortic stenosis (AS) increases with each decade of age. Transcatheter aortic valve replacement (TAVR) is a definitive treatment for AS, but there are scarce data on morbidity, mortality, and readmission risk after TAVR in patients with dementia.

Methods/materials: We identified all admissions for TAVR in patients with AS in the National Readmissions Database in 2017-2018 and stratified them according to the presence or absence of a secondary diagnosis of dementia. Inpatient outcomes were compared using logistic regression. Cox proportional-hazards models were used to compare 30-, 60-, and 90-day readmissions.

Results: A total of 48,923 index hospitalizations for TAVR were identified, of which 2192 (4.5 %) had a secondary diagnosis of dementia. Presence of dementia was associated with higher odds of delirium, pacemaker placement, acute kidney injury, and fall in hospital. The hazard of 30-day readmission was not significantly different between patients with and without dementia, but patients with dementia experienced a higher hazard of 60-day readmission (HR 1.15, 95 % CI 1.03-1.26, p = 0.011) in the unadjusted model and higher hazard of 90-day readmission in both unadjusted (HR 1.18, 95 % CI 1.08-1.30, p < 0.001) and adjusted models (aHR 1.14, 95 % CI 1.04-1.25, p = 0.004).

Conclusions: Patients with dementia who undergo TAVR are at higher risk of in-hospital adverse outcomes and 60- and 90-day readmissions compared with patients without dementia. These estimates should be integrated into shared decision-making discussions with patients and families.

Keywords: Aortic stenosis; Dementia; Readmission; TAVI; TAVR.

Figure 1.. Disposition after discharge from index hospitalization

Bar graphs depict the disposition of patients with (red) and without (blue) dementia after being discharged from index hospitalization for transcatheter aortic valve replacement. All differences were significant (P <0.001).

Figure 2.. Kaplan-Meier curves of readmissions after TAVR in patients with and without dementia

Kaplan-Meier curves illustrate 30-day (Figure 2A), 60-day (Figure 2B), and 90-day (Figure 2C) readmission-free probability plotted against days from index TAVR in patients with and without dementia. The red and blue curves represent patients with dementia and those without dementia, respectively. Hazard ratio above 1 indicates higher hazard of readmission in patients with dementia compared with those without dementia. Abbreviations: aHR = adjusted hazard ratio; HR = hazard ratio; TAVR = transcatheter aortic valve replacement

Figure 3.. Kaplan-Meier curves of 90-day readmissions stratified to elective and non-elective TAVR

Kaplan-Meier curves illustrate 90-day readmission-free probability plotted against days from index TAVR stratified to elective TAVR (Figure 3A) and non-elective TAVR (Figure 3B). The red and blue curves represent patients with dementia and those without dementia, respectively. Hazard ratio above 1 indicates higher hazard of readmission in patients with dementia compared with those without dementia. Abbreviations: aHR = adjusted hazard ratio; HR = hazard ratio; TAVR = transcatheter aortic valve replacement

Figure 4.. Potential risk factors of 90-day readmission in patients with dementia

The figures display covariates associated with 90-day readmission in patients with dementia. A hazard ratio greater than 1 denotes association with 90-day readmission and vice versa. The vertical line of each covariate depicts the hazard ratio, and the perpendicular horizontal line shows its 95% confidence interval. Model 1 (Figure 4A) includes baseline and procedural characteristics whereas Model 2 (Figure 4B) additionally includes in-hospital outcomes. Hypovolemic shock and intracranial hemorrhage are not shown as their values were undefined.