NCDR Study Finds AFib Associated With Higher One-Year Mortality, HF in TMVR Patients

Patients undergoing transcatheter mitral valve repair (TMVR) who have atrial fibrillation (AFib) have higher rates of mortality and heart failure (HF) after one year than those without AFib, according to a study published March 18 in JACC: Cardiovascular Interventions.

Using data from the STS/ACC TVT Registry, Sameer Arora, MD, et al., compared one-year outcomes for patients with and without AFib who had TMVR with MitraClip between 2013 and 2016. The primary outcome was the composite rate of death or HF hospitalizations one year after the procedure. Secondary outcomes were one-year rates of stroke and bleeding events.

The results show that among 5,613 patients undergoing TMVR, 63 percent had AFib at baseline. Patients with AFib were more likely to have a history of stroke, chronic kidney disease or end-stage renal disease, and have a persistent pacemaker or ICD. AFib patients also were less likely to have a history of myocardial infarction or prior PCI. After the procedure, inpatient mortality was similar for patients with and without AFib (2.7 percent vs. 2.0 percent). Post-TMVR length of stay was 7.7 days for AFib patients vs. 7 days for those without. Among patients who did not have AFib at baseline (2,058), 78 developed AFib after the procedure.

The researchers determined one-year outcomes by linking STS/ACC TVT Registry data to Centers for Medicare and Medicaid Services claims data. Of the original cohort of 5,613 patients, one-year outcomes data was available for 3,261 patients. Presence of AFib at baseline was associated with higher composite rate of death or HF hospitalization after one year (38.4 percent vs. 30.8 percent). The stroke rate at one year was similar for patients with and without AFib (3.6 percent vs. 3.2 percent), but AFib patients were more likely to experience a bleeding event within one year (20.9 percent vs. 16.3 percent).

According to the researchers, the study's results highlight the need to "better understand which patients most benefit" from TMVR. Future research is necessary to determine whether early treatment of mitral regurgitation reduces the risk of AFib and to identify strategies to improve outcomes for patients with mitral regurgitation and AFib, they conclude.

The study's findings "provide valuable information on the role of AFib on one-year outcomes" in TMVR patients, Dritan Poçi, MD, PhD, writes in an accompanying editorial commentary. He adds that the results "put light into the importance of better evaluation of patients" before TMVR.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Interventions and Structural Heart Disease, Mitral Regurgitation

Keywords: National Cardiovascular Data Registries, STS/ACC TVT Registry, Atrial Fibrillation, Mitral Valve Insufficiency, Mitral Valve, Length of Stay, Centers for Medicare and Medicaid Services (U.S.), Inpatients, Stroke, Medicare, Heart Failure, Medicaid, Myocardial Infarction, Renal Insufficiency, Chronic, Kidney Failure, Chronic, Registries, Pacemaker, Artificial, Percutaneous Coronary Intervention, Cohort Studies

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