How depression, cognitive dysfunction impact long-term TAVR outcomes

Baseline depression and cognitive dysfunction (CD) are both independently associated with a higher risk of long-term mortality among patients undergoing transcatheter aortic valve replacement (TAVR), according to new findings published in Circulation: Cardiovascular Interventions.[1]

“In one multicenter study, nearly one-third of TAVR patients screened positive for baseline depression and this was independently associated with increased one-year mortality,” wrote first author Bassim Rashad El-Sabawi, MD, a senior resident with the division of cardiovascular medicine at Vanderbilt University Medical Center, and colleagues. “CD has been reported in 18% to 32% of TAVR patients using various assessment tools and has been associated with increased mid-term mortality. However, the associations of depression and CD with long-term post-TAVR mortality and quality of life (QoL) are unknown.”

El-Sabawi et al. examined data from nearly 900 patients who underwent TAVR at one of 11 U.S. facilities from May 2014 to February 2017. According to pre-TAVR screening, performed with  “simple, validated screening tools,” depression was seen in 19.6% of patients, while CD was seen in 31.8%.

Patients with depression were more likely to be frail and present with a poor functional status. There was not a significant difference in aortic stenosis severity or procedural characteristics between patients with and without depression.

Patients with CD, meanwhile, were older and more likely to present with a prior dementia diagnosis. Again, there was no significant difference in aortic stenosis or procedural characteristics between patients with and without CD.