Patients with scheduled heart valve interventions are at very high risk for acute heart failure during prolonged waiting time

Stefanie Andreß (Ulm)1, D. Felbel (Ulm)1, W. Rottbauer (Ulm)1, A. Imhof (Ulm)1, T. Stephan (Ulm)1

1Universitätsklinikum Ulm Klinik für Innere Medizin II Ulm, Deutschland


Background: Postponement of non-emergency cardiac interventions is associated with increased rates of emergency hospitalizations. Affected patients show signs of acute heart failure during the waiting time. Since this worse outcome has been proven to persist even long post-procedure, patients at risk must be identified in advance.

Purpose: This study sought to identify predictors associated with acute heart failure during prolonged waiting time in cardiac patients scheduled for non-emergency interventions.

Methods: A retrospective, observational cohort study was conducted that included consecutive patients whose non-emergency cardiac intervention was postponed during the first Covid-19 related lockdown between March 19th and April 30th, 2020. The endpoint was heart failure at admission to the procedure performed, indicated by a NT-proBNP level > 900 pg/ml. Cox regression analysis was performed to identify characteristics of patients who met the endpoint.

Results: After postponing their non-emergency cardiac intervention for an average of 23 days, 89 of 178 postponed patients (59 %) at a mean age slightly above 70 years had a NT-proBNP level > 900 pg/ml. Cox regression analysis showed the criterion “planned heart valve procedure” to independently predict achievement of the endpoint (p < 0.001, OR 12.040, 95 % CI 3.423 – 42.353)..Subgroup analysis (n = 49) showed that especially patients with atrioventricular valve regurgitation are at risk with an endpoint rate of 94.74 % compared to 69.00 % in patients undergoing aortic valve replacement (p = 0.008). Moreover, the intervention of the affected patients was performed more frequently as emergency hospitalization (p = 0.005) and lasted longer (p < 0.001). This was accompanied by worse cardiac status at the time of admission including worse NYHA class, higher biomarker levels and lower cardiac function (each p < 0.001). Additionally, worse outcome as demonstrated by higher rates of emergency hospitalization and death persisted even 12, 24 and 36 months after the procedure (each p < 0.001).


Conclusion: Patients scheduled for heart valve interventions and particularly due to atrioventricular valve regurgitation are at high risk of heart failure in case of prolonged waiting time. Therefore, this population does not appear to be suitable for postponement but, in contrast, seems to require acute cardiovascular care.

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