Duke Clinical Research Institute and Division of Cardiology, Duke University School of Medicine, Durham, North Carolina.
Duke Clinical Research Institute and Division of Cardiology, Duke University School of Medicine, Durham, North Carolina.
J Am Coll Cardiol. 2019 Mar 19;73(10):1135-1146. doi: 10.1016/j.jacc.2018.12.049.
Patients with severe aortic stenosis (AS) have repeat hospitalizations for multiple conditions.
The purpose of this study was to assess the effect of transcatheter aortic valve replacement (TAVR) on hospitalizations in severe AS.
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.
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).
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.
患有严重主动脉瓣狭窄（AS）的患者会因多种疾病多次住院。
本研究旨在评估经导管主动脉瓣置换术（TAVR）对严重 AS 患者住院的影响。
使用来自胸外科医师学会/美国心脏病学会 TVT（经导管瓣膜治疗）注册中心的数据，并与医疗保险索赔进行关联，作者检查了 TAVR 前和 TAVR 后全因、心血管和非心血管住院率和住院天数以及住院费用。使用多变量模型确定 TAVR 后与 TAVR 前住院率和费用的比率比。
在有医疗保险关联的 328 个地点接受 TAVR 的 15324 名患者中，中位年龄为 84 岁，胸外科医师学会预测死亡率评分中位数为 7.0，61.1%的患者经股动脉入路进行 TAVR。与 TAVR 前相比，TAVR 后心力衰竭住院率和住院天数降低（比率比分别为 0.87 和 0.95；p<0.01 ）。然而，全因、非心血管和出血住院率和住院天数增加（p<0.01 ）。左心室射血分数<30%的患者 TAVR 后住院率降低最多。所有 TAVR 患者和 1 年幸存者的 TAVR 后平均费用均降低（比率比分别为 0.95，p<0.01；和 0.90，p<0.01）。
患者 TAVR 后住院费用降低，心力衰竭住院率降低，但全因、非心血管和出血住院率升高。住院率因特定患者亚组而异，因此，寻求降低资源使用的支付者和提供者可能会考虑制定策略，以改善 TAVR 后资源利用增加的患者的护理流程，与 TAVR 前相比。
