Nearly 1 in 5 older adults undergoing TAVR experience early HF hospitalization, which is associated with markedly increased short- and long-term mortality, with an adjusted hazard ratio of 3.17 for death.
Key Findings
Results
Early post-TAVR heart failure hospitalization occurred in approximately 1 in 5 older patients undergoing the procedure.
Among 233,309 patients undergoing TAVR, 45,502 (19.5%) experienced HF hospitalization within 1 year.
Early post-TAVR HF hospitalization was defined as at least 1 HF readmission occurring between 31 and 365 days after the index procedure.
The study population consisted of Medicare fee-for-service beneficiaries ≥65 years who underwent TAVR between January 1, 2017, and November 30, 2021.
Data were derived from the Medicare Provider Analysis and Review (MedPAR) database.
Results
Early HF hospitalization after TAVR was associated with markedly higher 1-year and 5-year mortality compared to patients without HF hospitalization.
1-year mortality was 43.8% in patients with early HF hospitalization versus 3.6% in those without (log-rank P<0.001).
5-year mortality was 80.6% in patients with early HF hospitalization versus 41.0% in those without (log-rank P<0.001).
The absolute difference in 1-year mortality between groups was 40.2 percentage points.
The absolute difference in 5-year mortality between groups was 39.6 percentage points.
Results
After multivariable adjustment, early HF hospitalization was strongly and independently associated with increased mortality.
Adjusted hazard ratio for mortality associated with early HF hospitalization was 3.17 (95% CI, 3.11–3.22).
Cox proportional hazards models were used with adjustment for clinical, procedural, and sociodemographic factors.
The association remained robust after multivariable adjustment, indicating it was not fully explained by baseline confounders.
Results
Advanced cardiac damage stage was the strongest predictor of early HF hospitalization after TAVR.
Advanced cardiac damage stage had an adjusted subdistribution hazard ratio of 1.95 (95% CI, 1.88–2.02) for early HF hospitalization.
Risk was graded across cardiac damage stages, suggesting a dose-response relationship.
Cardiac damage staging was among the clinical factors evaluated as predictors using competing-risk regression models.
Results
High-risk frailty was the second strongest predictor of early HF hospitalization after TAVR.
High-risk frailty had an adjusted subdistribution hazard ratio of 1.65 (95% CI, 1.58–1.72) for early HF hospitalization.
Graded risk was observed across frailty levels, consistent with a dose-response pattern.
Frailty was assessed using claims-based frailty measures available in the Medicare database.
Methods
The study characterized the incidence and prognostic significance of early post-TAVR HF hospitalization in a large, nationally representative older adult population.
The cohort of 233,309 patients is one of the largest reported for post-TAVR outcomes research.
The study period spanned nearly 5 years (January 1, 2017 to November 30, 2021), capturing contemporary TAVR practice.
The use of the Medicare MedPAR database allowed for population-level assessment of fee-for-service beneficiaries ≥65 years.
The authors note that the incidence and prognostic significance of early postprocedural HF hospitalization had remained 'incompletely characterized' prior to this study.
What This Means
This research examined what happens when older patients are hospitalized for heart failure after undergoing transcatheter aortic valve replacement (TAVR), a minimally invasive procedure to replace a diseased heart valve. Using Medicare records from over 233,000 patients aged 65 and older, the researchers found that about 1 in 5 patients (19.5%) were readmitted to the hospital for heart failure within the first year after their TAVR procedure. This is a substantial proportion of a patient population that had the procedure specifically to improve their heart condition.
The consequences of these early heart failure hospitalizations were severe. Patients who were rehospitalized for heart failure had a 1-year death rate of nearly 44%, compared to just 3.6% in those who were not rehospitalized — more than a tenfold difference. By 5 years, more than 80% of those with early heart failure hospitalizations had died, versus 41% of those without. Even after accounting for differences in patient health and other factors, being rehospitalized for heart failure tripled the risk of death. The two strongest factors predicting who would be rehospitalized were having more advanced heart damage before the procedure and being classified as high-risk for frailty.
This research suggests that early heart failure readmission after TAVR is both common and carries a very serious prognosis for older patients. The findings highlight the potential importance of identifying patients at highest risk — particularly those with advanced cardiac damage or frailty — before or shortly after the procedure, as these individuals may need more intensive monitoring or supportive care. This could help guide clinical decision-making and the development of interventions aimed at reducing readmissions and improving survival in this vulnerable population.
Kundi H, Leon M, Cohen D, Popma A, Kobayashi Y, Redfors B, et al.. (2026). Early Postrranscatheter Aortic Valve Replacement Heart Failure Hospitalization and Outcomes in Older Patients.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.048751