Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, North Carolina, USA.
Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina, USA.
J Interv Cardiol. 2022 Aug 5;2022:6074368. doi: 10.1155/2022/6074368. eCollection 2022.
Since transcatheter aortic valve replacement (TAVR) first became approved for inoperable patients followed by high, intermediate-, and low-risk patients, referrals to TAVR centers have rapidly increased. The purpose of this study was to investigate referral patterns to a large academic TAVR center in the state of North Carolina and evaluate differences between externally and internally referred patients.
Data for all patients who underwent TAVR at our institution between November 2014 and March 2020 were pulled from the Transcatheter Valve Therapy Registry. The electronic medical record was used to determine the referral source. The descriptive statistical analysis was performed using Excel (Microsoft, Redmond, Washington).
491 patients underwent TAVR at our institution between November 2014 and March 2020. Half of the patients were referred by a cardiologist within the same health system ( = 250, 50.9%). Other referral sources included a cardiologist external to the health system ( = 210, = 42.8%) and a surgeon or proceduralist (such as urologist, surgeon, or gastroenterologist) during the workup for another procedure ( = 26, 5.3%). Over time, there was a trend toward an increasing proportion of patients referred by a cardiologist external to our system, but this trend did not reach statistical significance (20.0% in 2014, 29.2% in 2015, 30.7% in 2016, 53.0% in 2017, 36% in 2018, 48.4% in 2019, and 56.8% in 2020, =0.06 using the Mann-Kendall trend test). Externally referred patients were less likely to have private insurance and were more likely to have a reduced ejection fraction and had a higher mean gradient across the valve. Postprocedure, externally referred patients were more likely to have the procedure under moderate sedation and less likely to be discharged home.
This study presents the referral pattern to a large TAVR center in North Carolina. Over time, there was an increase in external referrals suggesting that TAVR is increasingly adopted as an important component of the management of aortic valve stenosis. Internally and externally referred patients have differences in baseline demographic and clinical characteristics which may have an impact on clinical outcomes.
自经导管主动脉瓣置换术（TAVR）首次获准用于无法手术的患者，随后又用于高危、中危和低危患者以来，转至 TAVR 中心的患者数量迅速增加。本研究旨在调查北卡罗来纳州一家大型学术 TAVR 中心的转诊模式，并评估外部和内部转诊患者之间的差异。
从我们机构在 2014 年 11 月至 2020 年 3 月期间接受 TAVR 的所有患者的经导管瓣膜治疗登记处中提取数据。电子病历用于确定转诊来源。使用 Excel（Microsoft，Redmond，Washington）进行描述性统计分析。
在我们机构，491 名患者接受了 TAVR。其中一半患者是由同一医疗系统内部的心脏病专家转诊的（ = 250，占 50.9%）。其他转诊来源包括医疗系统外部的心脏病专家（ = 210，占 42.8%）和在另一个程序的检查期间的外科医生或介入治疗师（如泌尿科医生、外科医生或胃肠病学家）（ = 26，占 5.3%）。随着时间的推移，越来越多的患者是由我们系统外部的心脏病专家转诊，尽管这种趋势没有达到统计学意义（2014 年为 20.0%，2015 年为 29.2%，2016 年为 30.7%，2017 年为 53.0%，2018 年为 36%，2019 年为 48.4%，2020 年为 56.8%，Mann-Kendall 趋势检验=0.06）。外部转诊患者更有可能没有私人保险，且射血分数更低，瓣上平均梯度更高。术后，外部转诊患者更有可能在中度镇静下进行手术，且更不可能出院回家。
本研究介绍了北卡罗来纳州一家大型 TAVR 中心的转诊模式。随着时间的推移，外部转诊人数有所增加，这表明 TAVR 越来越被视为治疗主动脉瓣狭窄的重要手段。内部和外部转诊患者在基线人口统计学和临床特征方面存在差异，这可能对临床结果产生影响。
