title: Association of Patient-Reported Health Status With Long-Term Mortality After Transcatheter Aortic Valve Replacement: Report From the STS/ACC TVT Registry.
abstract: BACKGROUND
  Although transcatheter aortic valve replacement (TAVR) is an effective treatment for aortic stenosis, long-term mortality after TAVR remains high and challenging to predict. The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a health status measure, assessed directly from patients, that integrates 2 clinically relevant factors (symptoms and functional status) that may predict TAVR outcomes.
  
  
  RESULTS
  Among 7769 patients from 286 sites in the Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry, we examined the association between preprocedure (baseline) patient health status, as assessed by the KCCQ, and 1-year mortality after TAVR. The KCCQ Overall Summary Score was categorized as very poor: <25, poor: 25 to 49, fair: 50 to 74, or good: ≥75. Before TAVR, health status was rated as very poor in 28%, poor in 38%, fair in 24%, and good in 10%. Patients with worse health status were more likely to be women and had more comorbidities and higher STS mortality risk scores. Compared with those with good health status before TAVR and after adjusting for a broad range of baseline covariates, patients with very poor health status had a 2-fold increased hazard of death over the first year after TAVR (adjusted hazard ratio, 2.00; 95% confidence interval, 1.58-2.54), whereas those with poor and fair health status had intermediate outcomes (adjusted hazard ratio, 1.54; 95% confidence interval, 1.22-1.95 and adjusted hazard ratio, 1.20; 95% confidence interval, 0.94-1.55, respectively).
  
  
  CONCLUSIONS
  In a national, contemporary practice cohort, worse preprocedure patient health status, as assessed by the KCCQ, was associated with greater long-term mortality after TAVR. These results support the measurement and integration of the KCCQ into mortality risk assessments for patients considering TAVR.
authors.affiliation: From the Department of Medicine, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (S.V.A., J.A.S., S.J.B., D.J.C.); Department of Medicine, Duke University, Durham, NC (S.V., D.D., S.M.O.); Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital (A.J.K., P.G.); Department of Cardiovascular Disease, Baylor Scott and White Health, Plano, TX (M.J.M.); Department of Medicine, Lahey Hospital and Medical Center and Harvard Clinical Research Institute, Boston, MA (M.R.R.); and Department of Medicine, Denver VA Medical Center, CO (J.S.R.). suz.v.arnold@gmail.com.
authors.forename: Suzanne V
authors.initials: SV
authors.lastname: Arnold
authors.affiliation: From the Department of Medicine, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (S.V.A., J.A.S., S.J.B., D.J.C.); Department of Medicine, Duke University, Durham, NC (S.V., D.D., S.M.O.); Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital (A.J.K., P.G.); Department of Cardiovascular Disease, Baylor Scott and White Health, Plano, TX (M.J.M.); Department of Medicine, Lahey Hospital and Medical Center and Harvard Clinical Research Institute, Boston, MA (M.R.R.); and Department of Medicine, Denver VA Medical Center, CO (J.S.R.).
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: From the Department of Medicine, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (S.V.A., J.A.S., S.J.B., D.J.C.); Department of Medicine, Duke University, Durham, NC (S.V., D.D., S.M.O.); Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital (A.J.K., P.G.); Department of Cardiovascular Disease, Baylor Scott and White Health, Plano, TX (M.J.M.); Department of Medicine, Lahey Hospital and Medical Center and Harvard Clinical Research Institute, Boston, MA (M.R.R.); and Department of Medicine, Denver VA Medical Center, CO (J.S.R.).
authors.forename: Sreekanth
authors.initials: S
authors.lastname: Vemulapalli
authors.affiliation: From the Department of Medicine, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (S.V.A., J.A.S., S.J.B., D.J.C.); Department of Medicine, Duke University, Durham, NC (S.V., D.D., S.M.O.); Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital (A.J.K., P.G.); Department of Cardiovascular Disease, Baylor Scott and White Health, Plano, TX (M.J.M.); Department of Medicine, Lahey Hospital and Medical Center and Harvard Clinical Research Institute, Boston, MA (M.R.R.); and Department of Medicine, Denver VA Medical Center, CO (J.S.R.).
authors.forename: Dadi
authors.initials: D
authors.lastname: Dai
authors.affiliation: From the Department of Medicine, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (S.V.A., J.A.S., S.J.B., D.J.C.); Department of Medicine, Duke University, Durham, NC (S.V., D.D., S.M.O.); Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital (A.J.K., P.G.); Department of Cardiovascular Disease, Baylor Scott and White Health, Plano, TX (M.J.M.); Department of Medicine, Lahey Hospital and Medical Center and Harvard Clinical Research Institute, Boston, MA (M.R.R.); and Department of Medicine, Denver VA Medical Center, CO (J.S.R.).
authors.forename: Sean M
authors.initials: SM
authors.lastname: O'Brien
authors.affiliation: From the Department of Medicine, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (S.V.A., J.A.S., S.J.B., D.J.C.); Department of Medicine, Duke University, Durham, NC (S.V., D.D., S.M.O.); Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital (A.J.K., P.G.); Department of Cardiovascular Disease, Baylor Scott and White Health, Plano, TX (M.J.M.); Department of Medicine, Lahey Hospital and Medical Center and Harvard Clinical Research Institute, Boston, MA (M.R.R.); and Department of Medicine, Denver VA Medical Center, CO (J.S.R.).
authors.forename: Suzanne J
authors.initials: SJ
authors.lastname: Baron
authors.affiliation: From the Department of Medicine, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (S.V.A., J.A.S., S.J.B., D.J.C.); Department of Medicine, Duke University, Durham, NC (S.V., D.D., S.M.O.); Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital (A.J.K., P.G.); Department of Cardiovascular Disease, Baylor Scott and White Health, Plano, TX (M.J.M.); Department of Medicine, Lahey Hospital and Medical Center and Harvard Clinical Research Institute, Boston, MA (M.R.R.); and Department of Medicine, Denver VA Medical Center, CO (J.S.R.).
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.affiliation: From the Department of Medicine, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (S.V.A., J.A.S., S.J.B., D.J.C.); Department of Medicine, Duke University, Durham, NC (S.V., D.D., S.M.O.); Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital (A.J.K., P.G.); Department of Cardiovascular Disease, Baylor Scott and White Health, Plano, TX (M.J.M.); Department of Medicine, Lahey Hospital and Medical Center and Harvard Clinical Research Institute, Boston, MA (M.R.R.); and Department of Medicine, Denver VA Medical Center, CO (J.S.R.).
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
authors.affiliation: From the Department of Medicine, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (S.V.A., J.A.S., S.J.B., D.J.C.); Department of Medicine, Duke University, Durham, NC (S.V., D.D., S.M.O.); Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital (A.J.K., P.G.); Department of Cardiovascular Disease, Baylor Scott and White Health, Plano, TX (M.J.M.); Department of Medicine, Lahey Hospital and Medical Center and Harvard Clinical Research Institute, Boston, MA (M.R.R.); and Department of Medicine, Denver VA Medical Center, CO (J.S.R.).
authors.forename: Philip
authors.initials: P
authors.lastname: Green
authors.affiliation: From the Department of Medicine, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (S.V.A., J.A.S., S.J.B., D.J.C.); Department of Medicine, Duke University, Durham, NC (S.V., D.D., S.M.O.); Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital (A.J.K., P.G.); Department of Cardiovascular Disease, Baylor Scott and White Health, Plano, TX (M.J.M.); Department of Medicine, Lahey Hospital and Medical Center and Harvard Clinical Research Institute, Boston, MA (M.R.R.); and Department of Medicine, Denver VA Medical Center, CO (J.S.R.).
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Reynolds
authors.affiliation: From the Department of Medicine, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (S.V.A., J.A.S., S.J.B., D.J.C.); Department of Medicine, Duke University, Durham, NC (S.V., D.D., S.M.O.); Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital (A.J.K., P.G.); Department of Cardiovascular Disease, Baylor Scott and White Health, Plano, TX (M.J.M.); Department of Medicine, Lahey Hospital and Medical Center and Harvard Clinical Research Institute, Boston, MA (M.R.R.); and Department of Medicine, Denver VA Medical Center, CO (J.S.R.).
authors.forename: John S
authors.initials: JS
authors.lastname: Rumsfeld
authors.affiliation: From the Department of Medicine, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (S.V.A., J.A.S., S.J.B., D.J.C.); Department of Medicine, Duke University, Durham, NC (S.V., D.D., S.M.O.); Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital (A.J.K., P.G.); Department of Cardiovascular Disease, Baylor Scott and White Health, Plano, TX (M.J.M.); Department of Medicine, Lahey Hospital and Medical Center and Harvard Clinical Research Institute, Boston, MA (M.R.R.); and Department of Medicine, Denver VA Medical Center, CO (J.S.R.).
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D012042:Registries; D011795:Surveys and Questionnaires; D065467:Transcatheter Aortic Valve Replacement
keywords: mortality; quality of life; transcatheter aortic valve replacement