Mortality rates and causes of death after cardiac interventions: real-world short- and long-term insights from the Netherlands.

objectiveThe aim of this study is to gain insight into mortality rates and causes of death after major cardiac interventions, using nationwide real-world data from the Netherlands.

methodsFor this retrospective observational study, data from Statistics Netherlands and the Dutch all-payer claims database in the period 2016-2019 were used to select the intervention groups: coronary artery bypass grafting (CABG), percutaneous coronary intervention, surgical aortic valve replacement (SAVR), SAVR + CABG, mitral valve surgery, transcatheter heart valve intervention, pulmonary vein isolation and minimally-invasive maze surgery. For all interventions, survival status, date, and cause of death were retrieved. Causes of death were clustered for cardiovascular (CV) and non-CV causes by their corresponding ICD-10 code at different time intervals up to 5 years after the intervention.

resultsA total of 203,001 interventions were included, and 13.7% (27,832) of the patients died during the 5‑year follow-up. Of these, 45.1% (12,560) were CV, and 54.9% (15,272) were non-CV deaths. After coronary revascularization, valve intervention, and aortic valve intervention and coronary revascularization combined, respectively, non-CV mortality increased from 14.2%, 12.9% and 20.7% at 30 days to 44.5%, 47.0% and 44.5% after 2 years. Of all deaths up to 5 years, 54.7%, 54.3% and 55.3% were non-CV.

conclusionInitially main cause of death after cardiac intervention is CV-related. The proportion of non-CV deaths increases during follow-up, impacting survival for all patients up to 5 years after intervention. (Fig. 1).