The Burden of Anemia on Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement: A Nationwide Analysis

Background/Significance:

Anemia is a common comorbidity among patients undergoing Transcatheter Aortic Valve Replacement (TAVR), affecting nearly one-third of this population. Anemia has been associated with increased mortality, procedural complications, and adverse outcomes. Anemia in TAVR patients can arise from pre-existing conditions or procedural factors, such as periprocedural bleeding, hemolysis, and the use of antiplatelet or anticoagulant therapy. Despite its prevalence, the impact of anemia on TAVR outcomes remains uncertain.

Purpose:

This study provides a nationwide perspective on anemia’s role in TAVR outcomes, addressing gaps in existing research. Findings may inform risk stratification, perioperative care strategies, and resource allocation. Improving anemia management could enhance patient outcomes and reduce healthcare burdens.

Methods:

We stratified patients who underwent TAVR in the national inpatient sample database from 2016 to 2020 by the presence or absence of anemia. Multivariable logistic regression was performed, adjusting for age, gender, race, income, insurance, comorbidity score, hospital location, and bed size. The primary outcome was mortality and postprocedural bleeding. Secondary outcomes were cardiac arrest (CA), cardiogenic shock (CS) and acute heart failure. A p-value < 0.05 was considered statistically significant. All analyses were performed in STATA.

Results:

Among 296,740 TAVR cases, 32% (n=94,920) had a history of anemia (TAVRAN), and these patients were older (79.06 ± 8.85 vs. 78.78 ± 8.39 years, p < 0.001), more likely to be female (48.9% vs. 42.5%, p < 0.001), and had higher rates of hypertension (81.9% vs. 74%, p < 0.001), peripheral vascular disease (11.1% vs. 9.7%, p < 0.001), chronic obstructive pulmonary disease (25.6% vs. 21.3%, p < 0.001), and pulmonary hypertension (11.7% vs. 8.7%, p < 0.001). TAVRAN patients experienced worse postprocedural outcomes, including higher in-hospital mortality (2.23% vs. 0.95%, AOR 1.22, 95% CI: 1.03–1.45, p = 0.024), increased risk of postprocedural bleeding (3.87% vs. 1.21%, AOR 2.94, 95% CI: 2.56–3.39, p < 0.001), greater likelihood of cardiac arrest (1.49% vs. 0.63%, AOR 1.55, 95% CI: 1.25–1.93, p < 0.001), higher rates of cardiogenic shock (3.76% vs. 1.14%, AOR 1.69, 95% CI: 1.43–1.99, p < 0.001), and increased incidence of acute heart failure (37.40% vs. 27.74%, AOR 1.22, 95% CI: 1.14–1.30, p < 0.001).

Conclusion:

Anemia in TAVR patients is associated with higher comorbidity burdens and adverse clinical outcomes, including increased mortality and procedural complications. These findings highlight the importance of identifying and managing anemia in TAVR patients, necessitating tailored perioperative strategies to optimize outcomes. Future research should focus on improving anemia management to enhance procedural success rates.