TAVR Patients Less Likely to Have HF Hospitalization Post-Procedure, NCDR Study Finds

TAVR patients with severe aortic stenosis (AS) may have fewer heart failure (HF) hospitalizations post-procedure but have higher rates of all-cause, noncardiovascular and bleeding hospitalizations, according to a study published March 11 in the Journal of the American College of Cardiology.

Sreekanth Vemulapalli, MD, et al., used the STS/ACC TVT Registry to look at the effect of TAVR on hospitalizations in patients with severe AS. The researchers linked registry data to Medicare claims data for 15,324 patients who underwent TAVR at 328 sites and examined rates of all-cause, cardiovascular and noncardiovascular hospitalizations and hospital days. In addition, the researchers looked at inpatient costs in the year before TAVR and the year after the procedure.

Results show that HF was the most common reason for hospitalization, occurring in 15.9 percent of patient in the year before TAVR and 14.2 percent in the year post-TAVR. Rates for all-cause, noncardiovascular and bleeding hospitalizations and hospital days increased in the year after the procedure. The top causes for noncardiovascular hospitalization included septicemia, pneumonia, inpatient rehabilitation and acute kidney injury. After excluding the TAVR hospitalization, the average inpatient Medicare cost was $21,519 in the year before TAVR, comparted with $20,425 in the year post-TAVR.

The researchers conclude that TAVR patients had an increase in all-cause, noncardiovascular and bleeding hospitalizations but a decrease in HF hospitalization in the year following the procedure. They note a slight decrease in Medicare costs in the year after TAVR. "Payers and providers seeking to streamline resource use may consider targeting strategies designed to improve processes of care" for post-TAVR patients, they conclude.

The study highlights the "possibilities offered by merging registries with large administrative databases," Bernard Iung, MD, FACC, writes in an editorial commentary that accompanied the study. He concludes that while the study "provides original and relevant information in a real-world setting," researchers should not "underestimate the challenges" of merging large databases.

Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Structural Heart Disease

Keywords: Registries, National Cardiovascular Data Registries, STS/ACC TVT Registry, Aortic Valve Stenosis, Acute Kidney Injury, Heart Failure, Medicare, Hospitalization, Transcatheter Aortic Valve Replacement

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