Post-mitral valve surgery, 5-year heart failure admissions increase with age from 13.9% (18–49y) to 27.0% (≥80y), with loop diuretic use decreasing but remaining high.
Following mitral valve surgery for mitral regurgitation, the risk of hospital admission for heart failure increases significantly with age, though loop diuretic use decreases postoperatively across all age groups.
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Abstract Background Symptoms of heart failure (HF) are a key indication for surgery in patients with chronic mitral regurgitation (MR), but limited data exist on how the burden of HF and the use of loop diuretics vary across age groups following surgery. Purpose To examine age-related differences in the incidence of admission for HF and loop diuretic use following mitral valve surgery for MR. Methods Using Danish nationwide registries, we identified all patients ≥18 years of age discharged following first-time non-transcatheter surgery for MR between 1996 and 2022, not related to endocarditis or acute ischemia. Patients were categorized into age groups (18–49, 50–59, 60–69, 70–79, and ≥80 years). HF was defined from in- and out-patient hospital diagnosis codes. Following discharge, the 5-year cumulative incidence of hospital admission for HF was examined. To assess relative incidence differences between age groups, we applied an adjusted multivariable Cox proportional hazards model. We assessed loop diuretic prescription redemption, as a surrogate marker for HF, during the 6 months before surgery for all patients and at 12–15 months postoperatively among those alive at 15 months. Results We identified 6,840 patients (median age 66.3 years, 65.9% male): 841 aged 18–49 (62.7% male), 1,346 aged 50–59 (71.8% male), 2,125 aged 60–69 (69.2% male), 2,153 aged 70–79 (61.5% male), and 375 aged ≥80 (53,9% male). The prevalence of a HF diagnosis prior to surgery was 23.1%, 28.5%, 30.0%, 32.9%, and 34.7% for the respective age groups. The 5-year cumulative incidence of hospital admission for HF was 13.9% (95% CI: 11.6–16.4%), 15.5% (95% CI: 13.6–17.6%), 21.3% (95% CI: 19.6–23.2%), 25.7% (95% CI: 23.7–27.6%), and 27.0% (95% CI: 22.3–31.9%), respectively, Figure 1. For patients without a HF diagnosis prior to surgery (N=4,788), the 5-year cumulative incidence of hospital admission for (de novo) HF was 8.8% (95% CI: 6.7–11.2%), 7.4% (95% CI: 5.8–9.3%), 14.0% (95% CI: 12.2–15.9%), 17.3% (95% CI: 15.2–19.4%), and 19.6% (95% CI: 14.7.4–25.2%), respectively. In the adjusted analysis, the hazard ratios for admission for HF were 0.94 (95% CI: 0.74-1.18, p=0.6) for patients aged 50–59, 1.23 (95% CI: 0.99-1.52, p=0.06) for patients aged 60–69, 1.34 (95% CI: 1.08-1.67, p=0.009) for patients aged 70–79 and 1.38 (95% CI: 1.03-1.86, p=0.03) for those aged ≥80, compared with patients aged 18–49. The proportion of patients with a redeemed loop diuretic prescription decreased following surgery across all age groups, Figure 2. Conclusion(s) In a nationwide cohort of patients undergoing mitral valve surgery for mitral regurgitation, the postoperative 5-year cumulative incidence of hospital admission for heart failure ranged from 13.9% to 27.0%, increasing progressively with age, with estimates for de novo heart failure admission showing a similar trend. Compared to preoperative use, the use of loop diuretics decreased but remained high postoperatively for all age groups.
Melchior et al. (Sat,) reported a other. Post-mitral valve surgery, 5-year heart failure admissions increase with age from 13.9% (18–49y) to 27.0% (≥80y), with loop diuretic use decreasing but remaining high.