New-onset AF after TAVR confers greater mortality, comorbidity risk
Patients with new-onset atrial fibrillation after transcatheter aortic valve replacement experienced higher morbidity than those with preexisting or no AF, according to research published in JACC: Cardiovascular Interventions.
After adjusting for patient characteristics and hospital TAVR volume, researchers found that patients with new-onset AF had significantly greater mortality at a median follow-up of 305 days compared with patients with no AF (adjusted HR = 2.06; 95% CI, 1.92-2.2) and preexisting AF (aHR = 1.35; 95% CI 1.26-1.45).
In addition, patients with new-onset AF after TAVR, compared with those with preexisting AF, also had greater risk for:
- bleeding (subdistribution HR = 1.66; 95% CI, 1.48-1.86);
- stroke (subdistribution HR = 1.92; 95% CI, 1.63-2.26); and
- HF admissions (subdistribution HR = 1.98; 95% CI 1.81-2.16).
“While patients with preexisting AF are at higher risk of mortality compared to patients with no AF, new-onset AF carries a significantly worse prognosis and is associated with a much higher risk of mortality,” Amgad Mentias, MD, MSc, cardiology fellow at the University of Iowa Carver College of Medicine, and colleagues wrote. “This was despite that new-onset AF patients had a lower burden of most comorbidities at baseline. Last, patients who undergo TAVR and develop new-onset AF have higher risk of stroke, bleeding and HF hospitalizations at follow-up compared to patients with preexisting AF.”
In other findings, researchers observed that unadjusted mortality was higher with new-onset AF (29.7 per 100 person-years) compared with preexisting AF (22.6 per 100 person-years) and no AF (12.8 per 100 person-years; P < .001) after follow-up of 73,732 person-years.
“New-onset atrial fibrillation after transcatheter aortic valve replacement is associated with worse long-term outcomes compared to patients with preexisting atrial fibrillation and patients with no AF,” the researchers wrote. “Further research is required to determine the optimum prevention and management of new-onset atrial fibrillation after transcatheter aortic valve replacement to improve short- and long-term outcomes.”
Researchers identified via Medicare inpatient claims of 72,660 patients (mean age, 82 years; 53% men; 92% white; 37% with diabetes) who underwent non-apical TAVR between 2014 and 2016. New-onset AF was defined as occurrence of AF during the TAVR admission or within 30 days after TAVR without prior AF history.
“The worse outcome in patients with new-onset AF may be due to postprocedural morbid and frail patients [being] more extensively rhythm-monitored and some healthier patients could have missed new-onset AF due to early discharge,” Troels Højsgaard Jørgensen, MD, and Lars Søndergaard, MD, DMSc, of the department of cardiology at the Rigshospitalet, Copenhagen University Hospital, Denmark, wrote in a related editorial. “In fact, patients with new-onset AF had significantly longer length of stay in the intensive care unit, a longer length index hospitalization and [were] more frequently re-hospitalized within 30 days (duration of classification) when compared to patients with preexisting AF or without AF.” – by Scott Buzby
Disclosures: One author reports he received grant support from Boston Scientific and Edwards Lifesciences. The other study authors and the editorial authors report no relevant financial disclosures.