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Ait Mokhtar O, Baouni M, Azzouz A, Azaza A, Kara M, Salem M, Dahimene N, Saidane M, Sik A, Ouabdesselam S, Benkhedda S. [Waiting time to transcatheter aortic valve implantation (TAVI) and mortality during wait period in Algeria]. Ann Cardiol Angeiol (Paris) 2024; 73:101765. [PMID: 38723318 DOI: 10.1016/j.ancard.2024.101765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Trans Aortic Valve Implantation (TAVI) has become the primary treatment for aortic stenosis in patients over 75 years old. Despite its clinical efficacy, it's adoption in emerging countries remains low due to the high cost of prostheses and limited healthcare funding resources. This leads to prolonged waiting times for the TAVI procedure, which may lead to complications; these data are missing particularly in emerging countries. AIMS To describe waiting time for TAVI and mortality rate in this waiting period. MATERIALS AND METHODS This was prospective registry, patients referred for TAVI were prospectively followed; waiting time was calculated from the first visit after referral to TAVI implantation, clinical and, call fellow up was performed every 3 months. We divided patients into two groups: Group 1 (G1) patients still awaiting TAVI (105 patients), and those who underwent TAVI (36 patients). Group 2 (G2) patients who died while awaiting TAVI (16 patients, 10,2 %). RESULTS Demographic characteristics were similar, with a tendency for older age in G2 (79.5 ± 5.7 years vs. 82.5 ± 7.4 years, p=0,06). G2 exhibited more left ventricular ejection fraction (LVEF) impairment (8.5% vs. 25%, p=0,03) and a higher rate of severe heart failure with dyspnea stages III or IV (2.8% vs. 12.5%, p<0,001). The mean follow-up in G1 was 242.9 ± 137.4 days; the waiting time for TAVI was 231.7 ± 134.1 days, and the average time between the first consultation and death while awaiting TAVI (G2) was 335.1 ± 167.4 days. CONCLUSION in our series, waiting time is high due to limited Trans aortic heart valve availability, mortality during this wait exceeds 10%. Adverse prognostic factors include impaired LVEF and severe dyspnea stages III or IV.
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Affiliation(s)
- O Ait Mokhtar
- Service de cardiologie A2, CHU Mustapha. Alger, Algérie; Cardiology oncology collaborative group (COCGR), Algérie.
| | - M Baouni
- Service de cardiologie A2, CHU Mustapha. Alger, Algérie
| | - A Azzouz
- Service de cardiologie A2, CHU Mustapha. Alger, Algérie
| | - A Azaza
- Service de cardiologie A2, CHU Mustapha. Alger, Algérie
| | - M Kara
- Service de cardiologie A2, CHU Mustapha. Alger, Algérie
| | - M Salem
- Service de cardiologie A2, CHU Mustapha. Alger, Algérie
| | - N Dahimene
- Service de cardiologie A2, CHU Mustapha. Alger, Algérie
| | - M Saidane
- Service de cardiologie A2, CHU Mustapha. Alger, Algérie
| | - A Sik
- Service de cardiologie A2, CHU Mustapha. Alger, Algérie
| | - S Ouabdesselam
- Service de cardiologie A2, CHU Mustapha. Alger, Algérie; Cardiology oncology collaborative group (COCGR), Algérie
| | - S Benkhedda
- Service de cardiologie A2, CHU Mustapha. Alger, Algérie; Cardiology oncology collaborative group (COCGR), Algérie
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de la Plaza Llamas R, Ortega Azor L, Hernández Yuste M, Gorini L, Latorre-Fragua RA, Díaz Candelas DA, Al Shwely Abduljabar F, Gemio del Rey IA. Quality-adjusted life years and surgical waiting list: Systematic review of the literature. World J Gastrointest Surg 2024; 16:1155-1164. [PMID: 38690041 PMCID: PMC11056653 DOI: 10.4240/wjgs.v16.i4.1155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/26/2024] [Accepted: 02/25/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND The quality-adjusted life year (QALY) is a metric that is increasingly used today in the field of health economics to evaluate the value of different medical treatments and procedures. Surgical waiting lists (SWLs) represent a pressing problem in public healthcare. The QALY measure has rarely been used in the context of surgery. It would be interesting to know how many QALYs are lost by patients on SWLs. AIM To investigate the relationship between QALYs and SWLs in a systematic review of the scientific literature. METHODS The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. An unlimited search was carried out in PubMed, updated on January 19, 2024. Data on the following variables were investigated and analyzed: Specialty, country of study, procedure under study, scale used to measure QALYs, the use of a theoretical or real-life model, objectives of the study and items measured, the economic value assigned to the QALY in the country in question, and the results and conclusions published. RESULTS Forty-eight articles were selected for the study. No data were found regarding QALYs lost on SWLs. The specialties in which QALYs were studied the most in relation to the waiting list were urology and general surgery, with 15 articles each. The country in which the most studies of QALYs were carried out was the United States (n = 21), followed by the United Kingdom (n = 9) and Canada (n = 7). The most studied procedure was organ transplantation (n = 39), including 15 kidney, 14 liver, 5 heart, 4 lung, and 1 intestinal. Arthroplasty (n = 4), cataract surgery (n = 2), bariatric surgery (n = 1), mosaicplasty (n = 1), and septoplasty (n = 1) completed the surgical interventions included. Thirty-nine of the models used were theoretical (the most frequently applied being the Markov model, n = 34), and nine were real-life. The survey used to measure quality of life in 11 articles was the European Quality of Life-5 dimensions, but in 32 articles the survey was not specified. The willingness-to-pay per QALY gained ranged from $100000 in the United States to €20000 in Spain. CONCLUSION The relationship between QALYs and SWLs has only rarely been studied in the literature. The rate of QALYs lost on SWLs has not been determined. Future research is warranted to address this issue.
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Affiliation(s)
- Roberto de la Plaza Llamas
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares 28871, Madrid, Spain
| | - Lorena Ortega Azor
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares 28871, Madrid, Spain
| | - Marina Hernández Yuste
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares 28871, Madrid, Spain
| | - Ludovica Gorini
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain
| | - Raquel Aránzazu Latorre-Fragua
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares 28871, Madrid, Spain
| | | | - Farah Al Shwely Abduljabar
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares 28871, Madrid, Spain
| | - Ignacio Antonio Gemio del Rey
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares 28871, Madrid, Spain
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Stehli J, Johnston R, Duffy SJ, Zaman S, Gusberti TDH, Dagan M, Stub D, Walton A. Waiting times of women vs. men undergoing transcatheter aortic valve implantation. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:691-698. [PMID: 36460051 DOI: 10.1093/ehjqcco/qcac081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/26/2022] [Accepted: 11/30/2022] [Indexed: 11/08/2023]
Abstract
AIMS Increasing transcatheter aortic valve implantation (TAVI) rates have resulted in prolonged waiting times. These have been associated with heart failure hospitalizations (HFH) and mortality yet sex differences have not yet been reported. METHODS AND RESULTS All patients who underwent TAVI for severe aortic stenosis at a tertiary referral hospital in Australia were prospectively included. Total waiting time was divided into 'work-up' waiting time (period from referral date until heart team approval) and, 'procedural' waiting time (period from heart team approval until procedure date). Patients were analysed according to sex. Cohorts were matched to correct for differences in baseline and procedural variables. The primary endpoints were waiting times. Secondary outcomes included a composite of 30-day mortality and HFH, quality of life, and mobility. A total of 407 patients (42% women) were included. After matching of the two cohorts (345 patients), women had significantly longer total waiting times than men: median 156 [interquartile range (IQR) 114-220] days in women vs. 147 [IQR 92-204] days in men (P = 0.037) including longer work-up (83 [IQR 50-128] vs. 71 [IQR 36-119], P = 0.15) and procedural waiting times (65 [IQR 44-100] vs. 58 [IQR 30-93], P = 0.042). Increasing waiting times were associated with higher 30-day mortality and HFH (P = 0.01 for work-up waiting time, P = 0.02 for procedural waiting time) and decreased 30-day mobility (P = 0.044 for procedural waiting time) in women, but not in men. CONCLUSION TAVI waiting times are significantly longer in women compared to men and are associated with increased mortality and HFH and reduced mobility at 30-days.
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Affiliation(s)
- Julia Stehli
- Monash University, Faculty of Medicine, Nursing and Health Sciences, Clayton, VIC 3800, Australia
| | - Rozanne Johnston
- Department of Cardiology, Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Stephen J Duffy
- Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Sarah Zaman
- Department of Cardiology, Westmead Hospital, Sydney, Westmead, NSW 2145, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, Westmead, NSW 2145, Australia
| | | | - Misha Dagan
- Department of Cardiology, Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Antony Walton
- Department of Cardiology, Alfred Hospital, Melbourne, VIC 3004, Australia
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Ryffel C, Alaour B, Tomii D, Okuno T, Temperli F, Bruno J, Ruberti A, Demirel C, Lanz J, Praz F, Stortecky S, Reineke D, Windecker S, Heg D, Pilgrim T. Impact of COVID-19 Surge Periods on Clinical Outcomes of Transcatheter Aortic Valve Implantation. Am J Cardiol 2023; 204:32-39. [PMID: 37536202 DOI: 10.1016/j.amjcard.2023.07.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/08/2023] [Accepted: 07/13/2023] [Indexed: 08/05/2023]
Abstract
Healthcare systems adopted various strategies to minimize the impact of the COVID-19 pandemic on clinical outcomes of patients with symptomatic severe aortic stenosis referred for transcatheter aortic valve implantation (TAVI). We aimed to compare baseline characteristics and procedural and clinical outcomes of patients who underwent TAVI during COVID-19 surge periods with those of patients who underwent TAVI during the nonsurge and prepandemic periods. In the prospective Bern TAVI registry, the pandemic period was divided into surge and nonsurge periods on the basis of the mean number of occupied beds in the intensive care unit in each month and matched with 11 months immediately preceding the pandemic. A total of 1,069 patients underwent TAVI between April 1, 2019 and December 31, 2021. Patients who underwent TAVI during surge periods had a higher surgical risk (Society of Thoracic Surgeons predicted risk of mortality) than that of patients who underwent TAVI during nonsurge and prepandemic periods. Diagnosis-to-procedure time (in days) was longer for patients who underwent TAVI during the surge period than during the nonsurge and prepandemic periods (95.20 ± 121.07 vs 70.99 ± 72.25 and 60.46 ± 75.43, both p <0.001). At 30 days, all-cause mortality was higher in the surge than in the nonsurge group (4.9 vs 1.1%, hazard ratio 4.68, 95% confidence interval 1.55 to 14.10, p = 0.006), and in the surge than in the prepandemic group (4.9 vs 1.3%, hazard ratio 3.67, 95% confidence interval 1.34 to 10.11, p = 0.012). In conclusion, TAVI during COVID-19 surge periods was associated with higher Society of Thoracic Surgeons predicted risk of mortality score, delayed procedure scheduling, and increased 30-day mortality than that of TAVI during nonsurge and prepandemic periods.
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Affiliation(s)
| | | | | | - Taishi Okuno
- Department of Cardiology, Bern University Hospital
| | | | - Jolie Bruno
- Department of Cardiology, Bern University Hospital
| | | | | | - Jonas Lanz
- Department of Cardiology, Bern University Hospital
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital
| | | | - David Reineke
- Department of Cardiac Surgery, Inselspital, Bern University Hospital
| | | | - Dik Heg
- CTU Bern, University of Bern, Bern, Switzerland
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Noble S, Mauler-Wittwer S, Poku NK. Geographic Determinants of Outcomes After TAVR: Should We Favour Timely Access to TAVR Rather Than High Volume Per Centre? Can J Cardiol 2023; 39:578-580. [PMID: 37173056 DOI: 10.1016/j.cjca.2023.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 03/29/2023] Open
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Peel JK, Neves Miranda R, Naimark D, Woodward G, Mamas MA, Madan M, Wijeysundera HC. Financial Incentives for Transcatheter Aortic Valve Implantation in Ontario, Canada: A Cost-Utility Analysis. J Am Heart Assoc 2022; 11:e025085. [PMID: 35411786 PMCID: PMC9238449 DOI: 10.1161/jaha.121.025085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Transcatheter aortic valve implantation (TAVI) is a minimally invasive therapy for patients with severe aortic stenosis, which has become standard of care. The objective of this study was to determine the maximum cost‐effective investment in TAVI care that should be made at a health system level to meet quality indicator goals. Methods and Results We performed a cost‐utility analysis using probabilistic patient‐level simulation of TAVI care from the Ontario, Canada, Ministry of Health perspective. Costs and health utilities were accrued over a 2‐year time horizon. We created 4 hypothetical strategies that represented TAVI care meeting ≥1 quality indicator targets, (1) reduced wait times, (2) reduced hospital length of stay, (3) reduced pacemaker use, and (4) combined strategy, and compared these with current TAVI care. Per‐person costs, quality‐adjusted life years, and clinical outcomes were estimated by the model. Using these, incremental net monetary benefits were calculated for each strategy at different cost‐effectiveness thresholds between $0 and $100 000 per quality‐adjusted life year. Clinical improvements over the current practice were estimated with all comparator strategies. In Ontario, achieving quality indicator benchmarks could avoid ≈26 wait‐list deaths and 200 wait‐list hospitalizations annually. Compared with current TAVI care, the incremental net monetary benefit for this strategy varied from $10 765 (±$8721) and $17 221 (±$8977). This would translate to an annual investment of between ≈$14 to ≈$22 million by the Ontario Ministry of Health to incentivize these performance measures being cost‐effective. Conclusions This study has quantified the modest annual investment required and substantial clinical benefit of meeting improvement goals in TAVI care.
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Affiliation(s)
- John K Peel
- Institute of Health Policy, Management, and EvaluationUniversity of Toronto Ontario Canada.,Department of Anesthesiology and Pain Medicine University of Toronto Ontario Canada.,Toronto Health Economics and Technology Assessment Collaborative Toronto Ontario Canada
| | - Rafael Neves Miranda
- Institute of Health Policy, Management, and EvaluationUniversity of Toronto Ontario Canada.,Toronto Health Economics and Technology Assessment Collaborative Toronto Ontario Canada
| | - David Naimark
- Institute of Health Policy, Management, and EvaluationUniversity of Toronto Ontario Canada.,Toronto Health Economics and Technology Assessment Collaborative Toronto Ontario Canada.,Sunnybrook Research InstituteSunnybrook Health Sciences Centre Toronto Ontario Canada.,Department of Medicine University of Toronto Ontario Canada
| | | | - Mamas A Mamas
- Keele Cardiovascular Research Group Keele University Keele United Kingdom
| | - Mina Madan
- Sunnybrook Research InstituteSunnybrook Health Sciences Centre Toronto Ontario Canada.,Department of Medicine University of Toronto Ontario Canada
| | - Harindra C Wijeysundera
- Institute of Health Policy, Management, and EvaluationUniversity of Toronto Ontario Canada.,Toronto Health Economics and Technology Assessment Collaborative Toronto Ontario Canada.,Sunnybrook Research InstituteSunnybrook Health Sciences Centre Toronto Ontario Canada.,Department of Medicine University of Toronto Ontario Canada
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Albassam O, Henning KA, Qiu F, Cram P, Sheth TN, Ko DT, Woodward G, Austin PC, Wijeysundera HC. Increasing Wait-Time Mortality for Severe Aortic Stenosis: A Population-Level Study of the Transition in Practice From Surgical Aortic Valve Replacement to Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2020; 13:e009297. [PMID: 33167700 DOI: 10.1161/circinterventions.120.009297] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has emerged as a reasonable alternative to surgical aortic valve replacement (SAVR) for patients with severe aortic stenosis (AS). There is limited data on temporal trends in wait-times and access to care for patients with AS, irrespective of treatment modality. We sought to investigate the trends in wait-times for the treatment (either SAVR or TAVR) of AS in Ontario, Canada, and to understand the drivers of wait-list mortality and hospitalization due to heart failure. METHODS In this population-level retrospective cohort study, we identified patients from April 1, 2012, to March 31, 2018, who were referred for treatment of symptomatic severe AS awaiting either SAVR or TAVR. The primary outcome was the median total wait-time from referral date to either SAVR or TAVR procedure. Primary clinical outcomes were all-cause mortality and heart failure-related hospitalizations while on the wait-list. RESULTS The referral cohort consisted of a total of 22 876 referrals for aortic valve replacement, with (N=8098) TAVR and (N=14 778) SAVR referrals. The mean and median wait times for the overall AVR cohort were 87 and 59 days, respectively. The TAVR subcohort had longer wait-times (median 84 days) compared with the SAVR subcohort (median 50 days). Year over year, there was a statistically significant an increase in wait-times (P<0.001) for the overall AS cohort as well as each of the TAVR (P<0.0001) and SAVR (P<0.0001) subgroups. Wait-time mortality was 2.5% (TAVR 5.2% and SAVR 1.05%), while the cumulative probability of heart failure hospitalization was 3.6% (TAVR 7.7% and SAVR 1.3%). CONCLUSIONS In patients with severe symptomatic AS awaiting aortic valve replacement, there has been a trend of increasing wait times for both SAVR and TAVR. This was associated with increasing mortality and hospitalizations related to heart failure while on the wait-list.
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Affiliation(s)
- Omar Albassam
- Schulich Heart Program, Sunnybrook Health Sciences Center (O.A., D.T.K., H.C.W.), University of Toronto, Canada
| | - Kayley A Henning
- ICES, Toronto, ON, Canada (K.A.H., F.Q., P.C., D.T.K., P.C.A., H.C.W.)
| | - Feng Qiu
- ICES, Toronto, ON, Canada (K.A.H., F.Q., P.C., D.T.K., P.C.A., H.C.W.)
| | - Peter Cram
- Department of Medicine (P.C., D.T.K., H.C.W.), University of Toronto, Canada
- ICES, Toronto, ON, Canada (K.A.H., F.Q., P.C., D.T.K., P.C.A., H.C.W.)
- Division of General Medicine, and Geriatrics, Sinai Health System and University Health Network, Toronto, ON, Canada (P.C.)
| | - Tej N Sheth
- Hamilton Health Sciences and Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, ON, Canada (T.N.S.)
| | - Dennis T Ko
- Schulich Heart Program, Sunnybrook Health Sciences Center (O.A., D.T.K., H.C.W.), University of Toronto, Canada
- Department of Medicine (P.C., D.T.K., H.C.W.), University of Toronto, Canada
- Institute for Health Policy Management and Evaluation (D.T.K., H.C.W.), University of Toronto, Canada
- ICES, Toronto, ON, Canada (K.A.H., F.Q., P.C., D.T.K., P.C.A., H.C.W.)
| | | | - Peter C Austin
- ICES, Toronto, ON, Canada (K.A.H., F.Q., P.C., D.T.K., P.C.A., H.C.W.)
| | - Harindra C Wijeysundera
- Schulich Heart Program, Sunnybrook Health Sciences Center (O.A., D.T.K., H.C.W.), University of Toronto, Canada
- Department of Medicine (P.C., D.T.K., H.C.W.), University of Toronto, Canada
- Institute for Health Policy Management and Evaluation (D.T.K., H.C.W.), University of Toronto, Canada
- ICES, Toronto, ON, Canada (K.A.H., F.Q., P.C., D.T.K., P.C.A., H.C.W.)
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Attisano T, Silverio A, Bellino M, Tumscitz C, Tarantino FF, Santarelli A, Baldi C, Citro R, Galasso G. Balloon aortic valvuloplasty for urgent treatment of severe aortic stenosis during coronavirus disease 2019 pandemic: a case report. ESC Heart Fail 2020; 7:4348-4352. [PMID: 32949219 PMCID: PMC7537034 DOI: 10.1002/ehf2.13003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 12/31/2022] Open
Abstract
An 86‐year‐old man affected by severe aortic stenosis (AS) was referred to our institution owing to decompensated heart failure. Three months before, the patient was scheduled for transcatheter aortic valve implantation (TAVI), which was postponed owing to the coronavirus disease 2019 (COVID‐19) outbreak. Owing to COVID‐19 suspicion, he underwent nasopharyngeal swab and was temporarily isolated. However, the rapid deterioration of clinical and haemodynamic conditions prompted us to perform balloon aortic valvuloplasty (BAV) as bridge to TAVI. The patient's haemodynamics improved; and the next day, the reverse transcriptase–polymerase chain reaction for COVID‐19 was negative. At Day 5, he underwent TAVI procedure. Subsequent clinical course was uneventful. During COVID‐19 pandemic, the deferral of TAVI procedure should be assessed on a case‐by‐case basis to avoid delay in patients at high risk for adverse events. BAV may be an option when TAVI is temporarily contraindicated such as in AS patients suspected for COVID‐19.
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Affiliation(s)
- Tiziana Attisano
- Interventional Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Angelo Silverio
- Interventional Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Michele Bellino
- Interventional Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Carlo Tumscitz
- Department of Cardiology, University Hospital of Ferrara, Ferrara, Italy
| | | | - Andrea Santarelli
- Interventional Cath Lab Unit, Cardiovascular Department, Infermi Hospital, Rimini, Italy
| | - Cesare Baldi
- Interventional Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Rodolfo Citro
- Interventional Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Gennaro Galasso
- Interventional Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
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Bariatric Surgery Offer in Brazil: a Macroeconomic Analysis of the Health system's Inequalities. Obes Surg 2020; 29:1874-1880. [PMID: 30739302 DOI: 10.1007/s11695-019-03761-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Brazil currently holds the second place in the worldwide ranking of the largest number of bariatric surgical procedures performed. The offer of bariatric surgery in the public health system is not sufficient for its demand; it remains to be determined whether the recent economic downturn affected this offer. OBJECTIVE To analyze the proportion of bariatric surgeries performed by the public system in Brazil and assess the influence of macroeconomic variables over time. METHODS This is a nationwide analysis which correlated the estimated number of bariatric surgeries in Brazil in both public and private health-providing systems from 2003 through 2017 with the main macroeconomic variables of Brazil during the evaluated period (gross domestic product [GDP], inflation rate, and unemployment rate), and both overall and public healthcare expenditures. RESULTS The proportion of surgeries performed in the public system varied from 7.1% in 2014 to 10.4% in 2004. There was a significant positive correlation between the public proportion of surgeries with the unemployment rate (R = 0.55666; P = 0.03868). There were significant negative correlations between the proportion of public surgeries with the public health expenditure per capita (R = - 0.88811; P = 0.00011) and with the public percentage of healthcare expenditure per capita (R = - 0.67133; P = 0.01683). CONCLUSION There were direct correlations between the number of public bariatric procedures and the unemployment rate, as well as with the public healthcare expenditure per capita. Despite the increase in the number of public procedures, its proportion reveals an insufficiency of the current offer of bariatric surgery provided by the public system.
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Ando T, Adegbala O, Villablanca P, Akintoye E, Ashraf S, Shokr M, Briasoulis A, Takagi H, Grines CL, Afonso L, Schreiber T. Incidence, Predictors, and In-Hospital Outcomes of Transcatheter Aortic Valve Implantation After Nonelective Admission in Comparison With Elective Admission: From the Nationwide Inpatient Sample Database. Am J Cardiol 2019; 123:100-107. [PMID: 30360892 DOI: 10.1016/j.amjcard.2018.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/18/2018] [Accepted: 09/21/2018] [Indexed: 12/15/2022]
Abstract
Candidates for transcatheter aortic valve implantation (TAVI) are generally older with multiple co-morbidities and are therefore susceptible to nonelective admissions before scheduled TAVI. Frequency, predictors, and outcomes of TAVI after nonelective admission are under-explored. We queried the Nationwide Inpatient Sample database, an administrative database, from January 2012 to September 2015 to identify hospitalization in those age ≥50 who had transarterial TAVI. A propensity-matched cohort was created to compare the outcomes between nonelective and elective admission who had TAVI. The primary outcome was in-hospital mortality. A total of 9,521 TAVI admissions were identified during the study period. Of these admissions, 22.3% were nonelective admissions. Pulmonary circulation disorders (adjusted odds ratio [aOR] 1.38), anemia (aOR 1.54), congestive heart failure (aOR 1.37), chronic kidney disease (aOR 1.28; all p <0.001), and atrial fibrillation (aOR 1.17, p = 0.006) were independent risk factors for nonelective admission. In a propensity-matched cohort (1,683 admissions in each cohort), in-hospital mortality was similar (4.0% vs 2.8%, p = 0.052). Nonelective admissions had higher rates of acute myocardial infarction (5.2% vs 0.7%), fatal arrhythmia (9.4% vs 6.0%), acute kidney injury (25.9% vs 17.1%), respiratory failure requiring intubation (0.26% vs 0.19%), cardiogenic shock (5.1% vs 2.1%; all p <0.001), and bleeding requiring transfusion (13.1% vs 10.1%, p = 0.006) during the index-hospitalization. Hospital length of stay (11.4 days vs 6.5 days, p <0.001) and hospital cost ($68,669 vs $57,442, p <0.001) were both increased in nonelective admissions. Nonelective admission accounted for approximately one-fifth of total TAVI with significantly different cohort profiles. Our results suggest that nonelective TAVI has higher adverse outcomes and increased health resource utilization. Expedition in TAVI process in high-risk cohorts may result in better outcomes.
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