Pre-procedural domiciliary care marks a high-risk TAVI population – a nationwide study
V Mikkelsen, J K Petersen, M Meibom, L M Soerensen, J A Povlsen, C J Terkelsen, A Eftekhari, M Schou, L Koeber, O de Backer, E L FosboelAbstract
Background
Transcatheter aortic valve implantation (TAVI) is increasingly performed in older and medically complex patients. Functional dependency, reflected by the need for domiciliary care, can help identify patients with limited physiological reserve. However, the prognostic impact of domiciliary care prior to TAVI remains unclear.
Purpose
To examine all-cause mortality and cumulative all-cause hospitalization days after TAVI according to domiciliary care prior to TAVI.
Method
In this nationwide cohort study, we included all adult patients undergoing first-time TAVI with an aortic stenosis diagnosis in Denmark between January 1, 2015, and December 31, 2023. Patients were categorized according to receipt of domiciliary care within 1 year prior to TAVI. We examined one-year all-cause mortality from date of TAVI and cumulative all-cause hospitalization days after TAVI discharge. All-cause mortality was assessed using Kaplan-Meier estimates and multivariable Cox regression. Cumulative all-cause hospitalization days were categorized as 0-14 or >14 days and analyzed using multivariable logistic regression. All multivariable models were adjusted for sex, calendar period of TAVI, diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease, previous cancer, prior stroke, chronic heart failure, malignancy and peripheral vascular disease and frailty. Frailty was defined using the Hospital Frailty Risk Score, which was based on ICD-10 diagnosis codes.
Results
Among 7,607 patients undergoing TAVI, 541 (7.1%) received domiciliary care prior to the procedure. These patients were older (median age 83 vs. 81 years), more frequently lived alone (76.7% vs. 40.5%), and had a higher burden of comorbidity and frailty based on diagnosis codes. The absolute 1-year mortality from discharge was 21.5% in patients receiving domiciliary care compared with 6.4% in those without. After multivariable adjustment, domiciliary care was independently associated with increased 1-year mortality (HR 3.30; 95% CI 2.65–4.10), (Panel A). Furthermore, domiciliary care was associated with higher odds risk of prolonged hospitalization (>14 cumulative days) within 1 year after TAVI (OR 2.94; 95% CI 2.41–3.59), (Panel B).
Conclusion
Pre-procedural domiciliary care identifies a subgroup of TAVI patients with markedly increased mortality and cumulative all-cause hospitalization days despite adjustments. Incorporating functional dependency into preprocedural assessment may enhance risk stratification and support patient counseling.Domiciliary care figures