Quality of life outcomes after transcatheter aortic valve implantation in a “real world” population: Insights from a prospective Canadian data base

Abstract Background Documentation of quality of life (QOL) of patients after transcatheter aortic valve implantation (TAVI) is a Canadian Cardiovascular Society Quality Indicator. National results have not been reported to date. Methods We conducted an observational cohort study including all TAVI patients, irrespective of surgical risk between January 2016 and June 2019 as documented in the British Columbia TAVI Registry. QOL was measured at baseline, 30-day and 1-year using the Kansas City Cardiomyopathy Questionnaire Overall Score (KCCQ-OS). We used linear regression modelling to examine factors associated with 30-day changes in QOL, logistic regression modelling to identify predictors of sustaining a poor outcome, and Cox regression modelling to ascertain risk estimates of the effect of QOL on 1-year mortality. Results The cohort included 1,706 patients [742 women (43.5%)]; median [interquartile range, IQR] age 83 (77,86). Median (IQR) baseline KCCQ-OS was 45 (28.2,67), indicating severe impairment. Patients alive at 1-year (91.3%) reported a mean improvement of 24.1 (95% CI, 22.7-25.6) points in the KCCQ-OS at 30-day, which was sustained at 1-year (25.3; 95% CI, 23.8,26.8). Older age, lower baseline health status, lower aortic valve gradient, lower hemoglobin, atrial fibrillation and non-transfemoral access were associated with worse 30-day QOL. At 1-year, 65% of patients had a favourable outcome; additional risk factors for 1-year mortality (8.7%) were male sex, NYHA Class IV, severe pulmonary and renal disease, diabetes, and in-patient status. Conclusions TAVI is associated with significant early improvement in QOL which is sustained at 1 year.  The inclusion of QOL can support treatment decision and patient-centred evaluation.