Gupta Tanush, Kalra Ankur, Kolte Dhaval, Khera Sahil, Villablanca Pedro A, Goel Kashish, Bortnick Anna E, Aronow Wilbert S, Panza Julio A, Kleiman Neal S, Abbott J Dawn, Slovut David P, Taub Cynthia C, Fonarow Gregg C, Reardon Michael J, Rihal Charanjit S, Garcia Mario J, Bhatt Deepak L
Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
Division of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Am J Cardiol. 2017 Nov 15;120(10):1869-1876. doi: 10.1016/j.amjcard.2017.07.102. Epub 2017 Aug 10.
We queried the National Inpatient Sample database from 2012 to 2014 to identify all patients aged ≥18 years undergoing transcatheter aortic valve implantation (TAVI) in the United States. Regional differences in TAVI utilization, in-hospital mortality, and health-care resource use were analyzed. Of 41,025 TAVI procedures in the United States between 2012 and 2014, 10,390 were performed in the Northeast, 9,090 in the Midwest, 14,095 in the South, and 7,450 in the West. Overall, the number of TAVI implants per million adults increased from 24.8 in 2012 to 63.2 in 2014. The utilization of TAVI increased during the study period in all 4 geographic regions, with the number of implants per million adults being highest in the Northeast, followed by the Midwest, South, and West, respectively. Overall in-hospital mortality was 4.2%. Compared with the Northeast, risk-adjusted in-hospital mortality was higher in the Midwest (adjusted odds ratio [aOR] 1.26 [1.07 to 1.48]) and the South (aOR 1.61 [1.40 to 1.85]) and similar in the West (aOR 1.00 [0.84 to 1.18]). Average length of stay was shorter in all other regions compared with the Northeast. Among patients surviving to discharge, disposition to a skilled nursing facility or home health care was most common in the Northeast, whereas home discharge was most common in the West. Average hospital costs were highest in the West. In conclusion, we observed significant regional differences in TAVI utilization, in-hospital mortality, and health-care resource use in the United States. The findings of our study may have important policy implications and should provide an impetus to understand the source of this regional variation.
我们查询了2012年至2014年的美国国家住院样本数据库，以识别美国境内所有年龄≥18岁且接受经导管主动脉瓣植入术（TAVI）的患者。分析了TAVI使用情况、住院死亡率和医疗资源使用方面的地区差异。在2012年至2014年美国的41025例TAVI手术中，10390例在东北部进行，9090例在中西部进行，14095例在南部进行，7450例在西部进行。总体而言，每百万成年人中TAVI植入数量从2012年的24.8例增加到2014年的63.2例。在研究期间，所有4个地理区域的TAVI使用率均有所上升，每百万成年人中的植入数量在东北部最高，其次分别是中西部、南部和西部。总体住院死亡率为4.2%。与东北部相比，中西部（调整后的优势比[aOR]为1.26[1.07至1.48]）和南部（aOR为1.61[1.40至1.85]）的风险调整后住院死亡率更高，而西部（aOR为1.00[0.84至1.18]）则与之相似。与东北部相比，所有其他地区的平均住院时间更短。在存活至出院的患者中，转至专业护理机构或接受家庭医疗护理在东北部最为常见，而回家出院在西部最为常见。西部的平均住院费用最高。总之，我们观察到美国在TAVI使用情况、住院死亡率和医疗资源使用方面存在显著的地区差异。我们的研究结果可能具有重要的政策意义，并应促使人们去了解这种地区差异的根源。
