Although chronic conditions are associated with worse survival following transcatheter aortic valve implantation (TAVI), a recent study published in JACC: Advances found that most patients with multiple chronic conditions (MCC) are alive one year post TAVI and show significant improvement in quality of life.

Linking 188,629 TAVI procedures (median age 82 years, 46% female) from the STS/ACC TVT Registry with Centers for Medicare and Medicaid Servies claims data, Benjamin Seth Wessler, MD, FACC, et al., investigated associations between chronic conditions and outcomes post TAVI. For this analysis, high MCC was defined as six or more chronic conditions while low MCC was less than four chronic conditions.

They found that MCC exposure was associated with greater risk of mortality at one year (high MCC vs. low MCC, adjusted hazard ratio, 2.33 [95% CI, 2.22-2.44]) and lower Kansas City Cardiomyopathy Questionnaire (KCCQ) scores at baseline (high MCC median score 37.5 vs. low MCC median score 5.7; p<0.001).

Despite these results, the average improvement in KCCQ scores was “large and appeared independent of chronic disease burden” (median score change high MCC 28.7 vs. low MCC 24.5, standardized difference: 13.8%). Wessler and colleagues also note that only 4.7% of patients experienced encounters with palliative care, and this outcome varied greatly by center.

“This analysis suggests that most high-risk patients experience significant improvement in symptoms after TAVI, and that these patients – independent of chronic disease burden – might very well achieve their treatment goals,” write the authors.

“Looking forward, the work of Wessler, et al., should be viewed not as the final word but as an important reference point for future inquiry,” add Mario Gössl, MD, PhD, MHA, FACC, and Steven M. Bradley, MD, MPH, FACC, in an accompanying editorial comment. “Longitudinal studies and registries must prioritize the sustained collection of [quality of life] and long-term survival to better capture the lived experience of TAVI recipients.”