TAVR Improved Quality of Life, Suggests Significant Benefits

Real-world patients who underwent transcatheter aortic valve replacement (TAVR) had positive health outcomes on par with patients selected to receive the procedure for clinical trials, suggests a study in JAMA Cardiology (JAMA Cardiol. 2017. doi:10.1001/jamacardio.2016.5302). 

“In clinical trials, TAVR has been shown to improve symptoms and quality of life,” Suzanne V Arnold, MD, cardiologist at Saint Luke's Mid America Heart Institute, and colleagues wrote. “As this technology moves into general clinical practice, evaluation of the health status outcomes among unselected patients treated with TAVR is of critical importance.”

The observational cohort study included patients with severe aortic stenosis who underwent TAVR at more than 450 clinical sites between November 2011 and March 2016 and were included in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (TVT) Registry. Researchers looked at symptoms and quality of life for 31,636 patients 30 days after the procedure and 7014 surviving patients 1 year after TAVR. Their average age was 84.

At baseline, the average patient score on the Kansas City Cardiomyopathy Questionnaire overall summary (KCCQ-OS)—on which higher scores indicate better quality of life and less symptom burden—was 42.3, signifying substantial health status impairment, according to the study.

“Surviving patients had, on average, large improvements in health status at 30 days that persisted to 1 year, with a mean improvement in the KCCQ-OS score of 27.6 points at 30 days and 31.9 points at 1 year,” researchers reported. “Overall, 62.3% of patients had a favorable outcome at 1 year (alive with reasonable quality of life [KCCQ-OS score, ≥60] and no significant decline [≥10 points] from baseline).”

Patients with severe lung disease, receiving dialysis, or very poor baseline health status were less likely to have favorable outcomes, they found.

In an accompanying editorial, Robert O. Bonow, MD, MS, and Patrick T. O’Gara, MD wrote that while the study was “a welcome analysis of the quality of life data existing in the TVT Registry” with “comforting findings,” they noted the lack of quality-of-life data for patients 1 year after the procedure was “a conundrum.” Consequently, the findings might overestimate the benefit of TAVR in older adults, they observed (JAMA Cardiol. 2017. doi:10.1001/jamacardio.2016.6002). 

“The editors believe these data are insightful,” Dr Bonow and Dr O'Gara wrote, “but we urge the TVT Registry to intensify its efforts for more comprehensive quality of life outcome data collection so that the cardiology community has a fuller comprehension of the benefits of this expensive and resource-intensive technology.”—Jolynn Tumolo