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Trends in TAVR and SAVR Among Older US Adults
Quick Takes
- Within a decade after the advent of TAVR, the number of older adults undergoing AVR increased by almost 60%, whereas the patient age remained similar with a slightly increasing comorbidity profile.
- Furthermore, this was accompanied by decreasing mortality, readmission, and non–home discharge rates.
- Given the rapid evolution of TAVR and declining SAVR volume, there is a need for ongoing monitoring to ensure both SAVR and TAVR remain safe treatment options for older adults with aortic stenosis.
Study Questions:
What are the trends in characteristics and outcomes of patients undergoing transcatheter (TAVR) and surgical aortic valve replacement (SAVR) in the United States?
Methods:
The investigators analyzed Medicare beneficiaries who underwent TAVR and SAVR from 2012–2019. They evaluated case volume, demographics, comorbidities, 1-year mortality, and discharge disposition. The outcomes were 30-day, 6-month, and 1-year all-cause mortality defined as death occurring within the respective time frame from the index hospitalization for an AVR. The authors also evaluated 30-day readmission, defined as all-cause rehospitalization within 30 days after the index hospitalization. Cox proportional hazard models were used to assess the annual change in outcomes.
Results:
Per 100,000 beneficiary-years, AVR increased from 107 to 156, TAVR increased from 19 to 101, whereas SAVR declined from 88 to 54. The median [interquartile range] age remained similar from 77 [71-83] years to 78 [72-84] years for overall AVR, decreased from 84 [79-88] years to 81 [75-86] years for TAVR, and decreased from 76 [71-81] years to 72 [68-77] years for SAVR. For all AVR patients, the prevalence of comorbidities remained relatively stable. The 1-year mortality for all AVR decreased from 11.9% to 9.4%. Annual change in the adjusted odds of 1-year mortality was 0.93 (95% confidence interval [CI], 0.92-0.94) for TAVR and 0.98 (95% CI, 0.97-0.99) for SAVR, and 0.94 (95% CI, 0.93-0.95) for all AVR. Patients discharged to home after AVR increased from 24.2% to 54.7%, primarily driven by increasing home discharge after TAVR.
Conclusions:
The authors concluded that the advent of TAVR has led to about a 60% increase in overall AVR in older adults.
Perspective:
This study reports that within a decade after the advent of TAVR, the number of older adults undergoing AVR increased by almost 60%, whereas the patient age remained similar with a slightly increasing comorbidity profile. Furthermore, this was accompanied by decreasing mortality, readmission, and non–home discharge rates. It is reassuring that increasing TAVR volume in patients with a lower-risk profile did not appear to worsen SAVR outcomes, and the overall AVR outcomes continued to improve. Given the rapid evolution of TAVR and declining SAVR volume, there is a need for ongoing monitoring to ensure both SAVR and TAVR remain safe treatment options for older adults with aortic stenosis.
Clinical Topics: Cardiac Surgery, Geriatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Prevention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and VHD, Interventions and Structural Heart Disease
Keywords: Aortic Valve Stenosis, Cardiac Surgical Procedures, Comorbidity, Geriatrics, Heart Valve Diseases, Heart Valve Prosthesis, Patient Discharge, Patient Readmission, Primary Prevention, Transcatheter Aortic Valve Replacement
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