NCDR Study Compares Hospitalization Rates, Medicare Costs Pre- vs. Post-TMVr

Patients undergoing transcatheter mitral valve repair (TMVr) may experience a decrease in hospitalizations for cardiovascular diagnoses and heart failure (HF) and lower HF-related Medicare costs in the year following the procedure, according to a study published Dec. 2 in JACC: Cardiovascular Interventions.

Using data from the STS/ACC TVT Registry, Jennifer A. Rymer, MD, MBA, et al., analyzed outcomes of 4,970 patients to assess the real-world impact of TMVr on hospitalizations and Medicare costs pre- vs. post-TMVr. The researchers linked registry clinical records to Medicare claims data to compare hospitalization rates and number of hospitalized days for HF, cardiovascular causes, bleeding, noncardiovascular hospitalizations and all-cause hospitalization, as well as Medicare payments for hospital care, one year before TMVr and one year following the procedure.

In the year before TMVr, HF hospitalization rates were 479 hospitalizations per 1,000 person-years vs. 370 hospitalizations per 1,000 person-years in the year after TMVr. Cardiovascular-related hospitalizations decreased from 838 hospitalizations pre-TMVr vs. 632 hospitalizations post-TMVr. However, bleeding and noncardiovascular hospitalizations increased in the year after TMVr. In addition, the rates of hospitalized days decreased for HF and cardiovascular causes.

In terms of cost, the odds of having no HF-related Medicare costs was 68.7 percent pre-procedure vs. 78.5 percent post-procedure. Among patients who did have post-TMVr costs, there was a significant increase in the average total Medicare costs per day alive ($49 pre-procedure vs. $131 post-procedure).

According to the researchers, TMVr is associated with a decrease in cardiovascular and HF hospitalizations and number of hospitalized days. While there was increase in the likelihood of having no HF-related Medicare inpatient costs in the year after the procedure, costs did increase for patients who incurred costs post-TMVr. Additional research is needed to "understand how to reduce hospitalizations and inpatient costs after TMVr," the authors conclude.

In an accompanying editorial comment, Harindra C. Wijeysundera, MD, PhD, and Maneesh Sud, MD, write that future research should prioritize "identifying the mechanisms responsible for the increase in noncardiovascular hospitalizations after TMVr and implementing personalized in-hospital or post-discharge strategies targeting those at greatest risk."

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Patient Discharge, Inpatients, Mitral Valve, Hospitalization, Registries, National Cardiovascular Data Registries, STS/ACC TVT Registry, Heart Failure

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