Patients Refusing Transcatheter Aortic Valve Replacement Even Once Have Poorer Clinical Outcomes. Issue 18 (18th September 2018)

• Record Type: Journal Article
• Authors: Shimura, Tetsuro; Yamamoto, Masanori; Kano, Seiji; Hosoba, Soh; Sago, Mitsuru; Kagase, Ai; Koyama, Yutaka; Tsujimoto, Satoshi; Otsuka, Toshiaki; Tada, Norio; Naganuma, Toru; Araki, Motoharu; Yamanaka, Futoshi; Shirai, Shinichi; Mizutani, Kazuki; Tabata, Minoru; Ueno, Hiroshi; Takagi, Kensuke; Higashimori, Akihiro; Watanabe, Yusuke; Hayashida, Kentaro
• Other Names: Yashima Fumiaki investigator.; Inohara Taku investigator.; Kakefuda Yuki investigator.; Arai Takahide investigator.; Yanagisawa Ryo investigator.; Hase Hiromu investigator.; Yoshijima Nobuhiro investigator.; Saito Tetsuya investigator.; Tsuruta Hikaru investigator.; Kawakami Takashi investigator.; Maekawa Yuichiro investigator.; Takashi Kohno investigator.; Yoshitake Akihiro investigator.; Iida Yasunori investigator.; Yamazaki Masataka investigator.; Shimizu Hideyuki investigator.; Yamada Yoshitake investigator.; Jinzaki Masahiro investigator.; Itabashi Yuji investigator.; Murata Mitsushige investigator.; Kawakami Michiyuki investigator.; Fukui Shogo investigator.; Sano Motoaki investigator.; Takahashi Tatsuo investigator.; Kato Hiroko investigator.; Nakagawa‐Tamura Izumi investigator.; Fukuda Keiichi investigator.; Kodama Atsuko investigator.; Sato Hirotomo investigator.; Teramoto Tomohiko investigator.; Kimura Masashi investigator.; Tsunaki Tatsuya investigator.; Watarai Shoko investigator.; Tsuzuki Masanao investigator.; Irokawa Keisuke investigator.; Shimizu Kazuki investigator.; Tsuchikane Etsuo investigator.; Suzuki Takahiko investigator.; Kobayashi Toshihiro investigator.; Shibata Kenichi investigator.; Okawa Yasuhide investigator.; Miyasaka Masaki investigator.; Enta Yusuke investigator.; Mizutani Yukiko investigator.; Inoue Arata investigator.; Ishii Kazunori investigator.; Kawamoto Hiroyoshi investigator.; Onishi Hirokazu investigator.; Mitomo Satoru investigator.; Nakamura Sunao investigator.; Yamawaki Masahiro investigator.; Sakamoto Yasunari investigator.; Honda Yosuke investigator.; Makino Kenji investigator.; Akatsu Yui investigator.; Shishido Koki investigator.; Ochiai Tomoki investigator.; Yamabe Tsuyoshi investigator.; Noguchi Kenichiro investigator.; Saito Shigeru investigator.; Isotani Akihito investigator.; Hayashi Masaomi investigator.; Kamioka Norihiko investigator.; Miura Mizuki investigator.; Morinaga Takashi investigator.; Kawaguchi Tomohiro investigator.; Yano Mariko investigator.; Hanyu Michiya investigator.; Arai Yoshio investigator.; Tsubota Hideki investigator.; Kudo Masafumi investigator.; Kuroda Yuki investigator.; Nakao Mana investigator.; Okai Tsukasa investigator.; Kajio Keiko investigator.; Shibayama Kentaro investigator.; Noguchi Masahiko investigator.; Kobunai Kotaro investigator.; Kato Nahoko investigator.; Watanabe Shun investigator.; Hiono Makoto investigator.; Onoda Hiroshi investigator.; Kuwahara Hiroyuki investigator.; Kataoka Akihisa investigator.; Hioki Hitofumi investigator.; Nara Yugo investigator.; Kawashima Hideyuki investigator.; Nagura Fukuko investigator.; Nakashima Makoto investigator.; Sasaki Kazuya investigator.; Nishikawa Junichi investigator.; Shimokawa Tomoki investigator.; Harada Tadanori investigator.; Katayama Taiga investigator.; Yukimitsu Nozomu investigator.; Takamura Shintaro investigator.; Yamamoto Hirosada investigator.; Kozuma Ken investigator.;
• Is Part Of: Journal of the American Heart Association. Volume 7:Issue 18(2018)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2018-09-18
• Subjects: Optimized Catheter Valvular Intervention -- refusal -- transcatheter aortic valve implantation -- transcatheter aortic valve replacement -- treatment delay; Heart -- Diseases -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; Cerebrovascular disease -- Periodicals; Cardiology -- Periodicals; 616.1
• DOI: 10.1161/JAHA.118.009195
• Languages: English
• ISSNs: 2047-9980

Abstract

Abstract : Background: Although transcatheter aortic valve replacement (TAVR) is the least invasive treatment for patients with symptomatic aortic stenosis, some patients hesitate to undergo the procedure. We investigated the clinical impact of treatment delay after patient refusal of TAVR. Methods and Results: We used the Japanese OCEAN (Optimized Catheter valvular intervention) regsitry data of 1542 patients who underwent TAVR. Refusal was defined as at least 1 refusal of TAVR at the time of informed consent. Patients were separated into 2 groups: refusal (28/1542, 1.8%) and non‐refusal (1514/1542, 98.2%). We compared the baseline characteristics, procedural outcomes, and mortality rates between the groups. Additionally, data on reasons for refusal and those leading to eventually undergoing TAVR were collected. Age, surgical risk scores, and frailty were higher in the refusal group than in the non‐refusal group ( P <0.05 for all). Periprocedural complications did not differ between groups, whereas 30‐day and cumulative 1‐year mortality were significantly higher in the refusal group than in the non‐refusal group (7.1% versus 1.3%, P =0.008 and 28.8% versus 10.3%, P =0.010, respectively). Multivariate Cox regression analysis revealed that TAVR refusal was an independent predictor of increased midterm mortality (hazard ratio: 3.37; 95% confidence interval: 1.52–7.48; P =0.003). The most common reason for refusal was fear (13/28, 46.4%), and the most common reason for changing their mind was worsening heart failure (21/28, 75.0%). All patients in the refusal group decided to undergo TAVR within 20 months (median: 5.5 months). Conclusions: Refusing TAVR even once led to poorer prognosis; therefore, this fact should be clearly discussed when obtaining informed consent.