Changes in Long‐Term Care Needs, Healthcare Costs, and Mortality Risk After Transcatheter Aortic Valve Implantation in Japan: The Longevity Improvement & Fair Evidence Study

AIM: Transcatheter aortic valve implantation (TAVI) is increasingly performed in older adults with severe aortic stenosis, but there is limited evidence on their post-procedure changes in care needs, healthcare costs, and mortality risk. METHODS: This retrospective cohort study used linked medical and long-term care (LTC) insurance claims data from 1361 patients aged ≥ 75 years who underwent TAVI in 13 Japanese municipalities. Patients were stratified into four groups by baseline certified care needs level: Independent (n = 725), Support Level 1-2 (n = 321), LTC Level 1-2 (n = 208), and LTC Level 3-5 (n = 107). RESULTS: Among 532 patients in the 36-month observation cohort, 53% were independent at baseline, and approximately half of those remained independent at 36 months. Monthly total medical and LTC costs at 36 months were approximately 5 times higher in the LTC Level 3-5 group than the Independent group. The LTC Level 3-5 group also showed significantly higher all-cause mortality (hazard ratio 3.19, 95% confidence interval 2.18-4.67). CONCLUSIONS: Higher baseline care needs are associated with poorer outcomes and higher costs after TAVI. Incorporating care needs levels into clinical assessments may inform clinical decision-making and resource planning in older populations.