Impact of Iron Deficiency Anemia on Outcomes After Transcatheter Aortic Valve Implantation: Insights From the Nationwide Readmission Database From 2016 to 2021

ABSTRACT Background Transcatheter aortic valve implantation (TAVI) has become an established intervention for severe symptomatic aortic stenosis, particularly in high‐risk and elderly patients. Although anemia is frequently encountered in this population, the specific role of iron deficiency anemia (IDA) in influencing outcomes following TAVI remains underexplored. Aims This study aims to evaluate the impact of iron deficiency anemia on clinical outcomes, resource utilization and readmission rates following TAVI using a large national database. Methods We conducted a retrospective, observational study using the Nationwide Readmission Database (NRD) from 2016 to 2021. Patients undergoing TAVI were identified by relevant ICD‐10‐Procedure Coding System (PCS) codes, and IDA was defined using ICD‐10‐Clinical Modification (CM) codes. Outcomes included in‐hospital mortality, 30‐day readmission, length of stay (LOS), transfusion requirements, and a range of complications. A 1:1 propensity score‐matched analysis was performed to account for potential confounders (e.g., demographics, comorbidities, hospital characteristics). Results Among 213,453 patients who underwent TAVI, 8993 (4.2%) had a documented diagnosis of IDA. Compared with non‐IDA patients, those with IDA experienced significantly higher rates of blood transfusion (14.75% vs. 5.33%; adjusted OR: 3.12, 95% CI: 2.78, 3.51; p < 0.001) and a greater incidence of post‐procedure bleeding (14.38% vs. 11.62%; adjusted OR: 1.29, 95% CI: 1.17, 1.41; p < 0.001). Although in‐hospital mortality did not differ significantly between the two groups (1.31% vs. 1.47%; p = 0.42), IDA was associated with a longer median LOS and higher 30‐day readmission rates (11.95% vs. 9.84%; adjusted OR: 1.27, 95% CI: 1.15, 1.41; p < 0.001). Advancing age, the presence of heart failure, and greater comorbidity burden (Elixhauser comorbidity index ≥ 7) emerged as key predictors of in‐hospital death. Conclusion Baseline IDA in patients undergoing TAVI is associated with increased transfusion requirements, prolonged hospitalization, and higher rates of 30‐day readmission, underscoring the clinical and economic burden of this modifiable risk factor. Its association with greater resource utilization and complications supports the need for more proactive identification and management of iron deficiency in TAVI candidates. Future randomized trials are needed to clarify whether preprocedural correction of IDA can reduce adverse events and improve long‐term outcomes in this population.