Project Summary Moderate to severe valvular heart disease is a major cause of morbidity and mortality for the aging U.S. population and transcatheter aortic valve replacement (TAVR) has revolutionized care for older adults with symptomatic aortic stenosis and elevated pre-procedural risk. Not all patients benefit from treatment and one third of TAVR patients remain severely symptomatic or die 1 year after treatment. Comorbid conditions are likely the major determinants of benefit following TAVR since half of all deaths following treatment are due to non-cardiac causes. No studies have explored the impact of multiple chronic conditions (MCC) on patient- centered outcomes following TAVR, nor studied the benefits of palliative care (PC) for high-risk patients. This proposal addresses knowledge gaps related to the significance of MCC and the use of early PC for high-risk cardiovascular patients. Aim 1 of this research will determine the impact of MCC on short-term quality of life (QOL), mortality, and PC use for high-risk TAVR patients enrolled in the Transcatheter Valve Therapy Registry. Aim 2 will use focus groups to characterize the care needs of high-risk older adults treated with TAVR. Aim 3 is a feasibility study of adding early PC to standard care for high-risk TAVR patients with MCC. The pilot trial will determine if PC can be introduced early after TAVR for patients likely to have PC needs. The primary outcome is short-term QOL as measured by Kansas City Cardiomyopathy Questionaire. Interventions for older adults with advanced VHD are rapidly increasing both in scope and availability. Completion of the aims will determine whether MCC for high-risk TAVR patients negatively impacts patient-centered outcomes and whether MCC can be used to identify patients who are likely to benefit from PC. Thus, this research aligns with the priorities of the National Institute on Aging to improve clinical care for patients with MCC. This mentored award will support essential training in PC research methods, registry analytics, implementation science and clinical trial management.