Abstract 13882: Impact of Dementia on Inpatient Outcomes and Readmission Risks After Transcatheter Aortic Valve Replacement

Abstract

Introduction: The prevalence of both aortic stenosis (AS) and dementia increases with age, but studies evaluating in-hospital outcomes and readmission risk after transcatheter aortic valve replacement (TAVR) in patients with dementia are scarce. Hypothesis: The presence of dementia is associated with higher rates of adverse in-hospital outcomes and readmissions following TAVR. Methods: Using the National Readmissions Database 2017-2018, we identified all admissions for TAVR in patients with AS and stratified them to those with and without dementia. We assessed delirium and falls in hospital using multivariable logistic regression, and 90-day readmissions using multivariable Cox proportional-hazard modeling, adjusted for demographics, comorbidities, hospital characteristics, primary payer, median income, and elective admission status. Results: Among 48,923 TAVR procedures, 2,192 (4.5%) were performed in patients with dementia. Patients with dementia experienced higher odds of delirium (adjusted odds ratio [aOR] 4.50, 95% confidence interval [CI] 3.35-6.05, p<0.01) and fall in hospital (aOR 2.34, 95% CI 1.39-3.95, p<0.01) during hospitalization for TAVR. Patients with dementia also experienced an increased hazard of 90-day readmission (adjusted hazard ratio 1.14, 95% CI 1.04-1.25, p<0.01) (Figure 1). Causes of 90-day readmission were mostly non-cardiovascular. Conclusions: Patients with dementia undergoing TAVR suffered from increased odds of delirium and falls, with a higher hazard of 90-day readmission after discharge. These findings should be integrated into shared decision-making before elective TAVR.