ICES, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
ICES, Toronto, Ontario, Canada.
JACC Cardiovasc Interv. 2021 Oct 25;14(20):2274-2281. doi: 10.1016/j.jcin.2021.08.007.
The objective of this study was to determine the effect of transcatheter mitral valve repair (TMVr) on hospitalization rates by assessing pre- and postprocedural hospitalization patterns.
TMVr has emerged as the treatment of choice for selected patients with mitral regurgitation, but the impact of these procedures on hospital utilization remains unclear.
All patients who underwent TMVr in Ontario, Canada, between 2011 and 2017 were included in this observational study using population-based data. Hospitalization person-year rates were assessed in the years before and after TMVr and 4 predefined intervals: 1 to 30, 31 to 90, 91 to 182, and 183 to 365 days. Main outcomes of interest were all-cause and heart failure (HF) hospitalizations. Poisson regression models were used to compare incidence rates across all time periods.
The study cohort included 523 patients. In the year preceding TMVr, 66.2% of patients were hospitalized compared with 47.4% in the year following. There were stepwise increases in both all-cause and HF hospitalization rates in the periods preceding the index procedure, and all postprocedural periods had significantly lower hospitalization rates. The adjusted rate ratios for all-cause and HF-related hospitalization in the year after TMVr were 0.65 (95% CI: 0.56-0.76) and 0.38 (95% CI: 0.29-0.51), respectively. All time periods had significant reductions in all-cause and HF hospitalization in the adjusted analysis.
In this population-based study, significant reductions were observed in both all-cause and HF-related hospitalizations in all time periods after TMVr compared with the year prior. This suggests that TMVr has a sustained effect on hospitalization rates despite a high-risk population.
本研究旨在通过评估术前和术后住院模式，确定经导管二尖瓣修复术（TMVr）对住院率的影响。
TMVr 已成为治疗特定二尖瓣反流患者的首选方法，但这些手术对医院利用的影响尚不清楚。
本观察性研究使用基于人群的数据，纳入了 2011 年至 2017 年间在加拿大安大略省接受 TMVr 的所有患者。在 TMVr 前后以及 4 个预设时间段（1 至 30 天、31 至 90 天、91 至 182 天和 183 至 365 天）评估住院人次率。主要观察终点为全因和心力衰竭（HF）住院。采用泊松回归模型比较所有时间段的发病率。
研究队列包括 523 名患者。在 TMVr 前一年，66.2%的患者住院，而在 TMVr 后一年，这一比例为 47.4%。在指数手术前的各个时间段，全因和 HF 住院率均呈逐步上升趋势，所有术后时间段的住院率均显著降低。TMVr 后一年全因和 HF 相关住院的调整后率比值分别为 0.65（95%CI：0.56-0.76）和 0.38（95%CI：0.29-0.51）。调整后分析所有时间段的全因和 HF 住院均显著减少。
在这项基于人群的研究中，与 TMVr 前一年相比，TMVr 后所有时间段的全因和 HF 相关住院均显著减少。这表明 TMVr 对住院率有持续影响，尽管患者人群风险较高。
