No mental illness impact on post-aortic valve replacement patients’ new-onset atrial fibrillation

Abstract

Aim: The mental illness (MEI) impact upon risk-adjusted first-time aortic valve replacement (AVR) or repeat AVR (r-AVR) outcomes is unknown. Comparing patients with and without new-onset postoperative atrial fibrillation or atrial flutter (POAF/AFL), this retrospective cohort investigation evaluated if MEI impacted patients’ risk-adjusted AVR/r-AVR outcomes.

Methods: Using de-identified New York Statewide Planning and Research Cooperative System (administrative) database reports, multivariable logistic regression models compared post-procedural POAF/AFL, 30-day readmission, and composite (i.e., 30-day operative mortality or morbidity) endpoints between MEI and non-MEI patients.

Results: From 2005-2018, there were 36,947 first-time AVR patients and 242 r-AVR patients; of these, 13.18% AVR (n = 4,868) and 16.94% r-AVR (n = 41) patients had preprocedural MEI diagnoses. Compared to non-MEI patients, MEI patients had increased rates of transcatheter vs. surgical procedures and higher pre-procedural risks including alcoholism, illegal drug use, tobacco product use, suicidal ideation, or other comorbidities (e.g., valvular disease, atherosclerotic disease, hypertension obesity, and anemia); they were younger, female, and non-Black/non-Hispanic, and had non-commercial (e.g., government or self-pay) insurance. Contrasted to non-MEI patients, MEI patients had no different risk-adjusted new onset of POAF (AVR P = 0.575; r-AVR P = 0.497), 30-day readmission (AVR P = 0.163; r-AVR P = 0.486), and mortality/morbidity composite (AVR P = 0.848; r-AVR P = 0.295) rates.

Conclusions: Despite MEI patients’ inherent higher pre-procedural AVR/r-AVR risk, no differences in the MEI vs. non-MEI risk-adjusted POAF/AFL, 30-day readmission, or composite rates were found; however, MEI patients more frequently were selected to receive transcatheter rather than open surgical procedures.

Keywords

Aortic stenosis / aortic valve replacement / surgical aortic valve replacement / transcatheter aortic valve replacement / valve-in-valve / repeat surgical aortic valve replacement / atrial fibrillation / mental illness / depression / anxiety

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