Impact of depression on TAVR wait time and post-TAVR outcomes: a population-based study

Aims: The rising demand for transcatheter aortic valve replacement (TAVR) has outpaced health system capacity, leading to prolonged wait times and adverse outcomes. The impact of pre-existing depression on outcomes while waiting for and after receiving TAVR is not well described. Methods and results: This population-based study in Ontario, Canada, included all TAVR referrals between April 2018 and March 2023. Depression was identified from provincial physician billing and hospitalization databases. Wait time was defined as the number of days from the TAVR referral to the first of either a TAVR procedure, death, or off-listing from the waitlist for other reasons. The outcomes of interest included mortality and unplanned hospitalization during the waiting period as well as post-TAVR. Outcomes were ascertained to 31 December 2023. We evaluated the relationship between depression and pre- and post-TAVR outcomes using multivariable cause-specific Cox proportional hazard models. The study cohort consisted of 12 789 patients referred for TAVR, of which 3956 (31%) had depression. The median wait time was similar in patients with and without depression (75 vs. 72 days). After adjustment, depression was not associated with differences in the rate of mortality or hospitalization during the waiting period. Similarly, depression was not associated with mortality 1-year post-TAVR. However, depression was associated with a higher rate of unplanned hospitalization post-TAVR (hazard ratio 1.10, 95% confidence interval 1.03-1.17). Conclusion: Nearly 1 in 3 patients referred for TAVR have pre-existing depression. While depression does not impact wait time-related outcomes, it is associated with unplanned rehospitalization after TAVR.