ACC 2017: Study finds patients with new-onset AF following TAVR have worse outcomes

March 18, 2017 – Less than half of new AF patients were discharged with oral anticoagulation.

A study by DCRI researchers found that 8.4 percent of 13,559 patients who received transcatheter aortic valve replacement (TAVR), a minimally invasive surgical procedure for aortic stenosis, developed new-onset atrial fibrillation (AF), a common type of heart arrhythmia.

Additionally, only 28.9 percent of new AF patients were discharged on oral anticoagulation, which is often prescribed to reduce the risk of stroke associated with atrial fibrillation. In-hospital mortality and stroke were significantly higher among patients developing post-procedure AF compared with those who did not. At one year, rates of death, stroke, and bleeding were high among patients with post-TAVR AF, and the differences persisted even after multivariable adjustment.

These results were presented on Saturday at the 66th annual Scientific Sessions of the American College of Cardiology (ACC), held in Washington, DC.

“The study showed that new-onset atrial fibrillation after TAVR is common, with low rates of anticoagulation at discharge, and an increased risk of in-hospital and one-year mortality and stroke,” said lead author and DCRI cardiology fellow Amit N. Vora, MD, MPH (pictured). “Management strategies for these high-risk patents seem to be variable, highlighting the need for additional studies to define the optimal antithrombotic strategy to improve outcomes.”

The study used data from the Society for Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (STS/ACC TVT) Registry, linked with Medicare data for patients undergoing TAVR from 2011-2015, and who developed post-procedure AF. Patients with AF prior to TAVR were excluded. Outcomes of interest included in-hospital mortality and stroke and all-cause mortality, stroke, and bleeding at 12 months.

In addition to Vora, Duke researchers on the paper were: David Dai, PhD; Roland Matsouaka, PhD; J. Kevin Harrison, MD; G. Chad Hughes, MD; Matthew Sherwood, MD; Jonathan Piccini, MD; Eric Peterson, MD, MPH, FAHA, FACC; and Sreekanth Vemulapalli, MD.