Author + information
- Sreekanth Vemulapalli1,
- Steven J. Lippmann2,
- Mitchell Krucoff3,
- Adrian Hernandez2,
- Lesley Curtis4,
- Ted Feldman5,
- Donald Glower6 and
- Bradley Hammill7
- 1Duke University Medical Center
- 2Invasive Cardiology Department, Central Clinical Hospital of the Ministry of Interior
- 3Duke University Medical Center/Duke Clinical Research Institute, Durham, North Carolina, United States
- 4Department of Cardiology, Swiss Cardiovascular Center, University Hospital, Bern, Switzerland
- 5Evanston Hospital, Evanston, Illinois, United States
- 6Cardiovascular Surgeon, Durham, North Carolina, United States
- 7R&D Headquarters, Terumo Corporatio
Transcatheter mitral valve (MV) repair using the MitraClip System is an option for mitral regurgitation (MR) patients at prohibitive risk for MV surgery. Healthcare resource utilization pre and post MitraClip remains understudied.
EVEREST II High-Risk Registry and REALISM Continued Access Study data was linked to Medicare inpatient claims to identify claims for high surgical risk functional and degenerative MR patients ≥65 years old who underwent MitraClip between 2007 and 2013. Enrollment in fee-for-service Medicare the year prior to MitraClip and the year following (or until death, if sooner) was required. Pre- and post-MitraClip all-cause stroke, myocardial infarction (MI), heart failure (HF), and bleeding hospitalizations were identified. Event rate ratios and cost ratios were estimated using log-Poisson and log-gamma multi-level models. Medicare inpatient payments were adjusted to 2010 US$.
Among 403 linked patients, the mean age was 80 years, 60% were male, mean baseline LVEF was 49.6%, 83.3% were NYHA class III/IV, 78.2% were MR grade 3+/4+, and 63.3% had functional MR. One-year post MitraClip procedure, all-cause hospitalization rates decreased from 1854 to 1243 / 1000 person-years, p<0.001. Hospitalization rates for HF decreased following MitraClip (749 vs. 288 /1000 person-years, p <0.001); changes in stroke, MI, and bleeding were not statistically significant. Overall mean Medicare costs per patient were not statistically different pre- and post-MitraClip though there was a significant decrease in mean costs among those that survived a full year after MitraClip ($18,131 [SD $25,130], vs. $11,679 [SD $22,486]; p=0.02).
MitraClip was associated with a reduction in the rate of all-cause and HF hospitalizations. One-year Medicare costs were reduced in those who survived a full year after the MitraClip procedure.
STRUCTURAL: Valvular Disease: Mitral