{"id":"b7390ec49774","type":"article","url":"https://hartvaat.nl/2026/05/25/1-op-5-oudere-patienten-heeft-hartfalen-opname-binnen-jaar-na-tavr-1-jaarsmortal/","title":"1 op 5 oudere patiënten heeft hartfalen-opname binnen jaar na TAVR — 1-jaarsmortaliteit 44% versus 4%","title_en":"","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American Heart Association","doi":"10.1161/JAHA.125.048751","source_url":"https://doi.org/10.1161/JAHA.125.048751","authors":["Harun Kundi","Martin Leon","David J Cohen","Alexandra Popma","Yukari Kobayashi","Bjorn Redfors","Lauren S Ranard","Maria C Alu","Julia B Thompson","Jennifer von Stein","Philipp von Stein","Guido Ascione","Afek Kodesh","Juan F Granada","Jeffrey J Popma"],"significance":7,"published":"2026-06-04","source_date":"2026-05-25","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/esc-richtlijn-kleplijden-2021/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"Retrospective cohort of US Medicare data: 233,309 patients ≥65 years who underwent TAVR between 2017 and 2021. In 45,502 (19.5%) a heart failure hospitalisation occurred between day 31 and day 365 post-procedure. These patients had markedly higher 1-year (43.8% vs 3.6%) and 5-year mortality (80.6% vs 41.0%). After adjustment the association remained strong (aHR 3.17; 95% CI 3.11-3.22). Strongest predictors were advanced cardiac damage stage (aSHR 1.95) and high-risk frailty (aSHR 1.65), with graded risk across stages. Early post-TAVR HF hospitalisation is a sentinel event and supports systematic frailty and cardiac damage staging before and after the procedure.","created":"2026-07-03T10:32:59Z","updated":"2026-07-03T13:31:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Retrospectieve cohortstudie van Amerikaanse Medicare-data: 233.309 patiënten ≥65 jaar die tussen 2017 en 2021 een TAVR ondergingen. Bij 45.502 (19,5%) volgde tussen dag 31 en dag 365 een opname voor hartfalen. Deze patiënten hadden een dramatisch verhoogde 1-jaarsmortaliteit (43,8% vs 3,6%) en 5-jaarsmortaliteit (80,6% vs 41,0%). Gecorrigeerd bleef het verband sterk (aHR 3,17; 95%-BI 3,11-3,22). De krachtigste voorspellers waren gevorderd 'cardiac damage stage' (aSHR 1,95) en hoog-risico kwetsbaarheid (aSHR 1,65), met gegradueerd risico over stadia. Vroege HF-opname na TAVR is dus een sentinel-event en pleit voor systematische screening op kwetsbaarheid en cardiac damage staging vóór en na de procedure.","abstract_original":"BACKGROUND: Transcatheter aortic valve replacement (TAVR) improves symptoms and survival in patients with severe aortic stenosis, yet the incidence and prognostic significance of early postprocedural heart failure (HF) hospitalization remain incompletely characterized. Our objective is to determine the incidence, clinical characteristics, prognostic implications, and predictors of early HF hospitalization after TAVR. METHODS: Using the Medicare Provider Analysis and Review database, we identified fee-for-service beneficiaries ≥65 years who underwent TAVR between January 1, 2017, and November 30, 2021. Early post-TAVR HF hospitalization was defined as at least 1 HF readmission occurring between 31 and 365 days after the index procedure. Patients were classified according to the presence or absence of HF hospitalization during this period. Cox proportional hazards models were used to evaluate the association with mortality after adjustment for clinical, procedural, and sociodemographic factors. RESULTS: Among 233 309 patients undergoing TAVR, 45 502 (19.5%) experienced HF hospitalization within 1 year. Patients with early HF hospitalization had markedly higher mortality compared with those without HF hospitalization, including 1-year mortality (43.8% versus 3.6%) and 5-year mortality (80.6% versus 41.0%) (log-rank P<0.001). After multivariable adjustment, early HF hospitalization was strongly associated with increased mortality (adjusted hazard ratio [HR], 3.17 [95% CI, 3.11-3.22]). The strongest predictors of early HF hospitalization were advanced cardiac damage stage (adjusted-subdistribution HR, 1.95 [95% CI, 1.88-2.02]) and high-risk frailty (adjusted-subdistribution HR, 1.65 [95% CI, 1.58-1.72]), with graded risk across stages. CONCLUSIONS: Nearly 1 in 5 older adults undergoing TAVR experience early HF hospitalization, which is associated with markedly increased short- and long-term mortality."}