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. 2023 Jan 23;16(2):179-188.
doi: 10.1016/j.jcin.2022.10.051.

Nursing Home Admission Following Transcatheter Aortic Valve Replacement: A Danish Nationwide Cohort Study

Jarl E Strange  1 , Caroline Sindet-Pedersen  2 , Anders Holt  3 , Mikkel P Andersen  4 , Christian Torp-Pedersen  4 , Lars Køber  5 , Gunnar H Gislason  6 , Jonas B Olesen  3 , Emil L Fosbøl  5
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Free article

Nursing Home Admission Following Transcatheter Aortic Valve Replacement: A Danish Nationwide Cohort Study

Jarl E Strange et al. JACC Cardiovasc Interv. .
Free article

Abstract

Background: Loss of autonomy associated with nursing home admission (NHA) is a concern for patients. Yet the incidence of NHA after transcatheter aortic valve replacement (TAVR) is unknown.

Objectives: The aim of this study was to investigate the incidence and factors associated with NHA following TAVR compared with the general population.

Methods: Through Danish registries, patients alive at discharge after TAVR were identified from January 2014 to October 2021. Patients were matched 1:5 on sex, age, and calendar year to the general population. The 3-year cumulative incidence and 95% CI of NHA were estimated using the Aalen-Johansen estimator, accounting for the competing risk for death. Through multivariate cause-specific Cox regression models, factors associated with NHA were examined.

Results: In total, 5,312 TAVR patients were matched to 26,560 control subjects with a median age of 81 years and 56.1% males. Comorbidity burden was higher for TAVR patients. The 3-year cumulative incidence of NHA was 6.3% (95% CI: 5.5%-7.1%) for TAVR patients compared with 5.8% (95% CI: 5.4%-6.1%) for the general population. For TAVR patients >85 years of age, the cumulative incidence of NHA was 11.6% (95% CI: 9.5%-13.8%), and the risk for death was 23.3% (95% CI: 20.4%-26.2%). Factors associated with NHA were increasing age, frailty, living alone, and atrial fibrillation.

Conclusions: TAVR was not associated with an increased incidence of NHA compared with the general population. Despite the increased incidence of NHA for TAVR patients >85 years of age, approximately 2 in 3 patients were still alive and not admitted to nursing homes 3 years after TAVR.

Keywords: age; epidemiology; mortality; nursing home; prognosis; transcatheter aortic valve replacement.

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Conflict of interest statement

Funding Support and Author Disclosures The present study was partially funded by grants from Torben og Alice Frimodts Fond, Dagmar Marshalls Fond, Eva og Henry Frænkels Mindefond, and Snedkermester Sophus Jacobsen og Hustru Astrid Jacobsens Fond. None of the funders had any influence on conceptualization, data gathering, or writing of the manuscript. Dr Køber has received speaker honoraria from Novo Nordisk, Novartis, AstraZeneca, Boehringer Ingelheim, and Bayer, all unrelated to this work. Dr Olesen has received speaker honoraria and consultancy fees from Bayer, Bristol Myers Squibb, and Pfizer, all unrelated to this work. Dr Fosbøl has received an independent research grant from the Novo Nordisk Foundation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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