Author + information
- Received January 8, 2018
- Revision received November 24, 2018
- Accepted December 16, 2018
- Published online March 11, 2019.
- Sreekanth Vemulapalli, MDa,∗ (, )@DCRINews,
- David Dai, MSa,
- Bradley G. Hammill, DrPHa,
- Suzanne J. Baron, MD, MScb,
- David J. Cohen, MD, MScb,
- Michael J. Mack, MDc and
- David R. Holmes Jr., MDd
- aDuke Clinical Research Institute and Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
- bDivision of Cardiology, Saint-Luke’s Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
- cDepartment of Cardiothoracic Surgery, The Heart Hospital Baylor Plano, Plano, Texas
- dDivision of Cardiology, Mayo Clinic, Rochester, Minnesota
- ↵∗Address for correspondence:
Dr. Sreekanth Vemulapalli, Duke University Medical Center, Box 3126, Durham, North Carolina 27710.
Background Patients with severe aortic stenosis (AS) have repeat hospitalizations for multiple conditions.
Objectives The purpose of this study was to assess the effect of transcatheter aortic valve replacement (TAVR) on hospitalizations in severe AS.
Methods Using data from the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) registry with linkage to Medicare claims, the authors examined rates of all-cause, cardiovascular, and noncardiovascular hospitalizations and hospital days, as well as inpatient costs in the year pre-TAVR and post-TAVR. Multivariable modeling was used to determine rate ratios of post-TAVR versus pre-TAVR hospitalizations and costs.
Results Among 15,324 patients at 328 sites with Medicare linkage undergoing TAVR, the median age was 84 years, the median Society of Thoracic Surgeons Predicted Risk of Mortality score was 7.0, and 61.1% patients underwent TAVR via transfemoral access. Post-TAVR, heart failure hospitalization rates and hospitalized days were reduced compared with pre-TAVR (rate ratio: 0.87 and 0.95 respectively; p < 0.01 for all). However, all-cause, noncardiovascular, and bleeding hospitalization rates and hospitalized days were increased (p < 0.01 for all). Post-TAVR hospitalizations were reduced the most among those with left ventricular ejection fraction <30%. Mean post-TAVR costs were reduced among all TAVR patients and among 1-year survivors (rate ratio: 0.95, p < 0.01; and 0.90; p < 0.01, respectively).
Conclusions Patients had lower costs and fewer heart failure hospitalizations but more all-cause, noncardiovascular, and bleeding hospitalizations post-TAVR. Reduction in hospitalizations varied by specific patient subgroups, and thus, payors and providers seeking to reduce resource use may consider strategies designed to improve processes of care among patients with increased resource utilization post-TAVR as compared with pre-TAVR.
This work was funded by the Society of Thoracic Surgeons and the American College of Cardiology. Dr. Vemulapalli has received research grants from the American College of Cardiology, the Society of Thoracic Surgeons, the Patient Centered Outcomes Research Institute, and Abbott Vascular; and has served as a consultant for Novella and Boston Scientific. Dr. Hammill has received research support from Abbott Vascular, GlaxoSmithKline, Novartis, Amgen, and Boston Scientific. Dr. Baron has received consulting/speaker fees from Edwards Lifesciences and St. Jude Medical; and has served as a consultant for Medtronic. Dr. Cohen has received research grant support from Medtronic, Edwards Lifesciences, and Boston Scientific; and has received consulting fees from Medtronic, Edwards Lifesciences, and St. Jude Medical. Dr. Mack has served as coprincipal investigator of clinical trials sponsored by Edwards Lifesciences and Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received January 8, 2018.
- Revision received November 24, 2018.
- Accepted December 16, 2018.
- 2019 American College of Cardiology Foundation
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