Despite great strides in diagnosis and management of heart failure (HF), this chronic illness continues to be a worldwide epidemic with approximately 23 million people afflicted across the globe. In the US, over 6.5 million carry a HF diagnosis with almost 90% of all HF deaths occurring in patients over the age of 70. Since one in five Americans are expected to be older than 65 years by 2050, almost 1,000,000 new HF cases are expected to be diagnosed every year. The staggering nature of these numbers only pales in comparison to current dismal HF survival statistics. The unavoidable natural history of HF continues to be characterized by the occurrence of repetitive hospital admissions. Not only are hospital readmissions demarcated as one of the most important risk factors associated with mortality; but also, a well-recognized trigger for additional hospital readmissions. Even when HF treatment guidelines have been recently updated; the mere fact that four HF societies have issued individual recommendations without reaching a common unifying consensus statement adds to the complexity of HF patient management. The purpose of this Editorial not only to fuel more interest on this topic but also to spark the notion that we have a potential catastrophe in our hands and is the responsibility of all health-care professionals to attend to this vital issue.

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Introduction: There are well documented differences in TAVR outcomes among men and women from pre-procedure to 30-days post procedure. However, there is less data comparing the long-term differences in outcomes between genders. This study investigated cardiovascular outcomes between these two groups within 6 months of undergoing a TAVR. Methods: We performed a retrospective study among patients undergoing TAVR between March 2018 and June 2020 at the University of Illinois-Chicago (UIC) in Chicago, Illinois. Primary outcomes included composite MACE (CV death, MI and/or CVA) and all-cause death. Secondary outcomes included change in peak gradient, mean gradient, aortic valve area, and ejection fraction. Outcomes were analyzed at 6 months following the procedure. T and Chi square tests were used to analyze continuous/categorical variables, respectively. Results: There was a total of 115 patients (female: 25, male: 90) in the analysis. The female cohort was older and had a higher BMI. At baseline, the women had a higher peak gradient when compared to the men (64 vs 48mmHg, p=0.03). At 6 months, MACE (female=1.7 vs male=7%, p=0.9) and all cause death (4 vs 4.4%, p=0.9) were statistically similar. There was no significant difference in the change in ejection fraction or aortic valve area between men and women. There was no difference between peak aortic valve gradient or mean aortic valve gradient (p>0.05) between the groups immediately after the procedure or at 6 months following TAVR. Conclusion: Despite having higher baseline aortic valve gradients, women appeared to have similar procedural success and 6-month outcomes following TAVR as compared to men in this analysis. Women presenting with higher baseline gradients suggest that they may be under-diagnosed or misdiagnosed leading to delays in care. Further screening and earlier referral for women is important to maintaining good outcomes.

Introduction: Chronic kidney disease (CKD) is known to accelerate the progression of aortic stenosis (AS) and portends adverse outcomes in patients treated with surgical valve replacement. Long-term outcomes in CKD patients after transcatheter aortic valve replacement (TAVR) have been less studied. The purpose of this study is to examine outcomes after TAVR in CKD patients as stratified by glomerular filtration rate (GFR). Hypothesis: CKD is associated with poorer outcomes after TAVR. Methods: Retrospective electronic medical record review from March 2018-June 2020 at the University of Illinois, Chicago and Jesse Brown Veteran’s Administration Medical Center (Chicago, Illinois) identified TAVR patients, who were included if they followed-up within 6 and 12 months of procedure. Patients were stratified into 4 classes by baseline GFR (mL/min): >90, 60-89, 30-59, <30 with the latter 3 groups comprising CKD patients. Outcomes were expressed as event rates and included 6 and 12-month MACE (all-cause mortality, MI, or CVA) and 30-day rehospitalization. Chi-square analysis was used to compare differences across GFR groups. Results: 118 patients (age 76±10 years, 79% male, 46% white) followed up at 6-months and 112 did so at 12-months. There were no statistically significant differences in baseline demographics or comorbidities between CKD and non-CKD patients. CKD patients were more likely to experience MACE compared to non-CKD patients at 6 (p=0.04) and 12-months (p=0.009, Fig. 1). CKD patients also had a higher rate of 30-day rehospitalization (p=0.003). Conclusion: Our results demonstrate that CKD portends adverse outcomes after TAVR with CKD patients experiencing an increased risk of 6 + 12-month MACE and 30-day re-hospitalization. Decreasing GFR correlated with higher rates of MACE at 6 and 12 months.