Abstract 11210: Trends in Invasive Treatment of Patients Hospitalized with Acute Decompensated Aortic Stenosis and Cardiogenic Shock

Abstract

Background: Prior to 2012, balloon aortic valvuloplasty (BAV) was the only potential intervention for patients with decompensated aortic stenosis (AS) and cardiogenic shock. Emergent transcatheter aortic valve replacement (TAVR) is now an option and has shown acceptable outcomes compared with elective TAVR. We explored how treatment patterns for AS and cardiogenic shock have shifted since TAVR was introduced. Methods: We identified hospitalizations of patients with AS and cardiogenic shock within the National Readmissions Database, the proportion treated with BAV or TAVR, and in-hospital mortality over the study period by treatment. Due to challenges in determining the timing of surgery vs. onset of shock, patients who underwent surgical AVR were excluded. Results: From 2010-2018, there were 17,297 hospitalizations for AS and cardiogenic shock, which have increased over time (Figure A legend). The proportion of hospitalizations where either BAV or TAVR was used has also increased (BAV 3.9%->7.1%; TAVR 3.8%->10.1%; Figure A). In-hospital mortality was very high but has significantly decreased over time for all treatment strategies (no invasive: 46.9%->35.5%; BAV: 45.7%->34.2%; TAVR 18.8%->8.9%; Figure B), with much lower mortality rates the TAVR group at all time points. Compared with BAV, patients treated with TAVR were less likely to require mechanical ventilation (TAVR 34.6% vs BAV 49.1%) or mechanical circulatory support (TAVR 19.9% vs BAV 30.6%; p<0.001 for both). Age and comorbidity burden were similar among groups. Conclusions: Over the past decade, hospitalizations for AS and cardiogenic shock have increased as has the proportion in which BAV or TAVR are emergently used. Although in-hospital mortality has declined over time, it remains very high, particularly among patients treated with BAV or those without intervention. This is likely in part due to the lower severity of cardiogenic shock of the patients treated with TAVR.