1
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Vervoort D, Tam DY, Fremes SE. Dissecting Aortic Stenosis Disparities in Ontario, Canada: Do Gaps Persist in the Transcatheter Era? Can J Cardiol 2023; 39:32-34. [PMID: 36367489 DOI: 10.1016/j.cjca.2022.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/23/2022] [Indexed: 01/10/2023] Open
Affiliation(s)
- Dominique Vervoort
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - Derrick Y Tam
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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2
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Tam DY, Sadri H. Annual Budget Impact Analysis Comparing Self-Expanding Transcatheter and Surgical Aortic Valve Replacement in Low-Risk Aortic Stenosis Patients. Can J Cardiol 2022; 38:1478-1484. [DOI: 10.1016/j.cjca.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 11/02/2022] Open
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3
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Vervoort D, Tam DY, Wijeysundera HC. Health Technology Assessment for Cardiovascular Digital Health Technologies and Artificial Intelligence: Why Is It Different? Can J Cardiol 2021; 38:259-266. [PMID: 34461229 DOI: 10.1016/j.cjca.2021.08.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/23/2021] [Accepted: 08/03/2021] [Indexed: 11/28/2022] Open
Abstract
Innovations in health care are growing exponentially, resulting in improved quality of and access to care, as well as rising societal costs of care and variable reimbursement. In recent years, digital health technologies and artificial intelligence have become of increasing interest in cardiovascular medicine owing to their unique ability to empower patients and to use increasing quantities of data for moving toward personalised and precision medicine. Health technology assessment agencies evaluate the money spent on a health care intervention or technology to attain a given clinical impact and make recommendations for reimbursement considerations. However, there is a scarcity of economic evaluations of cardiovascular digital health technologies and artificial intelligence. The current health technology assessment framework is not equipped to address the unique, dynamic, and unpredictable value considerations of these technologies and highlight the need to better approach the digital health technologies and artificial intelligence health technology assessment process. In this review, we compare digital health technologies and artificial intelligence with traditional health care technologies, review existing health technology assessment frameworks, and discuss challenges and opportunities related to cardiovascular digital health technologies and artificial intelligence health technology assessment. Specifically, we argue that health technology assessments for digital health technologies and artificial intelligence applications must allow for a much shorter device life cycle, given the rapid and even potentially continuously iterative nature of this technology, and thus an evidence base that maybe less mature, compared with traditional health technologies and interventions.
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Affiliation(s)
- Dominique Vervoort
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Derrick Y Tam
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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4
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Welle GA, El-Sabawi B, Thaden JJ, Greason KL, Klarich KW, Nkomo VT, Alkhouli MA, Guerrero ME, Crestanello JA, Gulati R, Rihal CS, Eleid MF. Effect of eliminating pre-discharge transthoracic echocardiogram on outcomes after TAVR. Catheter Cardiovasc Interv 2021; 99:861-866. [PMID: 34388299 DOI: 10.1002/ccd.29929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 07/12/2021] [Accepted: 08/08/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The aim of this study was to determine the safety of eliminating the pre-discharge transthoracic echocardiogram (TTE) on 30-day outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND TTE is utilized before, during, and after TAVR. Post-procedural, pre-discharge TTE assists in assessment of prosthesis function and detection of clinically significant paravalvular leak (PVL) after TAVR. METHODS Patients who underwent TAVR at Mayo Clinic from July 2018 to July 2019 were included in a prospective institutional registry. Patients undergoing TAVR prior to February 2019 received a pre-discharge TTE, while those undergoing TAVR after February 2019 did not. Both cohorts were evaluated with TTE at 30 days post-TAVR. RESULTS A total of 330 consecutive patients were included. Of these, 160 patients (age 81.1 ± 7.6) had routine pre-discharge TTE, while 170 patients (age 78.9 ± 7.5) were dismissed without routine pre-discharge TTE. Mortality at 30 days was similar between the two groups (0% and 1.2%, respectively). One episode of PVL requiring intervention (0.6%) occurred in the pre-discharge TTE group and none in the group without pre-discharge TTE at 30-day follow-up. There was a similar incidence of total composite primary and secondary adverse events between the cohort receiving a pre-discharge TTE and those without (28.1% vs. 25.3%, P = 0.56) at 30 days. The most common event was need for permanent pacemaker or ICD implantation in both groups (13.1% vs. 11.8%, P = 0.71). CONCLUSIONS Elimination of the pre-discharge TTE is safe and associated with comparable 30-day outcomes to routine pre-discharge TTE. These findings have implication for TAVR practice cost-efficiency and health care utilization.
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Affiliation(s)
- Garrett A Welle
- Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, Minnesota, USA
| | - Bassim El-Sabawi
- Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, Minnesota, USA
| | - Jeremy J Thaden
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Kevin L Greason
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Kyle W Klarich
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Mohamad A Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Mayra E Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Juan A Crestanello
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
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5
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Alkhouli M, Alqahtani F, Ziada KM, Aljohani S, Holmes DR, Mathew V. Contemporary trends in the management of aortic stenosis in the USA. Eur Heart J 2021; 41:921-928. [PMID: 31408096 DOI: 10.1093/eurheartj/ehz568] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/31/2019] [Accepted: 07/25/2019] [Indexed: 01/01/2023] Open
Abstract
AIMS To assess the contemporary trends in aortic stenosis (AS) interventions in the USA before and after the introduction of transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS We utilized the National-Inpatient-Sample to assess temporal trends in the incidence, cost, and outcomes of AS interventions between 1 January 2003 and 31 December 2016. During the study's period, AS interventions increased from 96 to 137 per 100 000 individuals > 60 years old, P < 0.001. In-hospital expenditure on AS interventions increased from $2.28 billion in 2003 to $4.33 in 2016 P < 0.001. Among patients who underwent aortic valve replacement, the proportion of TAVI increased from 11.9% in 2012 to 43.2% in 2016 (P < 0.001). Males and Hispanics had lower proportions of TAVI compared with females and White patients. Adjusted in-hospital mortality of isolated SAVR decreased from 5.4% in 2003 to 3.3% in 2016 (P < 0.001), whereas adjusted in-hospital mortality of TAVI decreased from 4.7% in 2012 to 2.2% in 2016, P < 0.001. The incidence of new dialysis, permanent pacemaker implantation, and blood transfusion decreased after both TAVI and SAVR between 2012 and 2016. However, the rate of post-operative stroke did not significantly decrease. Length of stay and cost of hospitalization decreased after both SAVR and TAVI, although the later remained higher with TAVI. Rates of non-home discharge decreased over time after TAVI but remained stable after isolated SAVR. CONCLUSION This nationwide survey documents the increasing incidence of AS interventions, the rising cost of modern AS care, and the paradigm shift in aortic valve replacement practice in the USA.
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Affiliation(s)
- Mohamad Alkhouli
- Division of Cardiology, Department of Medicine, West Virginia University, 1 Medical Drive, Morgantown, WV 26505, USA.,Department of Cardiology, Mayo Clinic School of Medicine, 200 First St. SW Rochester, MN 55905, USA
| | - Fahad Alqahtani
- Division of Cardiology, Department of Medicine, West Virginia University, 1 Medical Drive, Morgantown, WV 26505, USA
| | - Khaled M Ziada
- Division of Cardiovascular Medicine, University of Kentucky, 326 C.T. Wethington Bldg, 900 S Limestone St, Lexington, KY 40536, USA
| | - Sami Aljohani
- Division of Cardiology, Department of Medicine, West Virginia University, 1 Medical Drive, Morgantown, WV 26505, USA
| | - David R Holmes
- Department of Cardiology, Mayo Clinic School of Medicine, 200 First St. SW Rochester, MN 55905, USA
| | - Verghese Mathew
- Division of Cardiology, Loyola University Chicago Stritch School of Medicine, 2160 S 1st Ave, Maywood, IL 60153, USA
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6
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Tam DY, Miranda RN, Elbatarny M, Wijeysundera HC. Real-World Health-Economic Considerations Around Aortic-Valve Replacement in a Publicly Funded Health System. Can J Cardiol 2021; 37:992-1003. [PMID: 33940193 DOI: 10.1016/j.cjca.2020.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 11/24/2022] Open
Abstract
Herein, we describe the unique interplay among biomedical ethics, principles of distributive justice, and economic theory to highlight the role of health technology assessments to compare therapeutic options for aortic valve replacement. From the perspective of the Canadian health care system, transcatheter aortic-valve implantation is associated with higher costs but also higher incremental health benefits compared with surgical aortic-valve replacement. At current willingness to pay thresholds, transcatheter aortic-valve replacement is likely cost effective across the spectrum of risk, from inoperable patients to those at low surgical risk. However, we highlight the nuances within each subgroup of surgical risk that merit careful consideration by the heart team. Moreover, incorporation of patients and their preferences in decision-making is key. In particular, in young, low-risk patients, there remains uncertainty regarding the optimal treatment, with unique concerns around valve durability, selection of valve prosthesis, and consideration for special procedures such as the Ross procedure. Nonetheless, current research suggests that, universally, patients prefer a less invasive approach compared with a more invasive approach. Finally, we highlight that there remain critical issues around timeliness of access to care and unacceptable geographic inequities across Canada. Further research into alternative funding mechanisms and integrated cross-sector care pathways is necessary to address these issues.
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Affiliation(s)
- Derrick Y Tam
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Rafael Neves Miranda
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Malak Elbatarny
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada.
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7
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Ybarra LF, Rinfret S, Brilakis ES, Karmpaliotis D, Azzalini L, Grantham JA, Kandzari DE, Mashayekhi K, Spratt JC, Wijeysundera HC, Ali ZA, Buller CE, Carlino M, Cohen DJ, Cutlip DE, De Martini T, Di Mario C, Farb A, Finn AV, Galassi AR, Gibson CM, Hanratty C, Hill JM, Jaffer FA, Krucoff MW, Lombardi WL, Maehara A, Magee PFA, Mehran R, Moses JW, Nicholson WJ, Onuma Y, Sianos G, Sumitsuji S, Tsuchikane E, Virmani R, Walsh SJ, Werner GS, Yamane M, Stone GW, Rinfret S, Stone GW. Definitions and Clinical Trial Design Principles for Coronary Artery Chronic Total Occlusion Therapies: CTO-ARC Consensus Recommendations. Circulation 2021; 143:479-500. [PMID: 33523728 DOI: 10.1161/circulationaha.120.046754] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Over the past 2 decades, chronic total occlusion (CTO) percutaneous coronary intervention has developed into its own subspecialty of interventional cardiology. Dedicated terminology, techniques, devices, courses, and training programs have enabled progressive advancements. However, only a few randomized trials have been performed to evaluate the safety and efficacy of CTO percutaneous coronary intervention. Moreover, several published observational studies have shown conflicting data. Part of the paucity of clinical data stems from the fact that prior studies have been suboptimally designed and performed. The absence of standardized end points and the discrepancy in definitions also prevent consistency and uniform interpretability of reported results in CTO intervention. To standardize the field, we therefore assembled a broad consortium comprising academicians, practicing physicians, researchers, medical society representatives, and regulators (US Food and Drug Administration) to develop methods, end points, biomarkers, parameters, data, materials, processes, procedures, evaluations, tools, and techniques for CTO interventions. This article summarizes the effort and is organized into 3 sections: key elements and procedural definitions, end point definitions, and clinical trial design principles. The Chronic Total Occlusion Academic Research Consortium is a first step toward improved comparability and interpretability of study results, supplying an increasingly growing body of CTO percutaneous coronary intervention evidence.
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Affiliation(s)
- Luiz F Ybarra
- London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada (L.F.Y.)
| | - Stéphane Rinfret
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada (S.R.)
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (E.S.B.)
| | - Dimitri Karmpaliotis
- New York-Presbyterian Hospital/Columbia University Medical Center, NY (D.K., Z.A.A., A.M., J.W.M.).,The Cardiovascular Research Foundation, New York, NY (D.K., A.M., Z.A.A., J.W.M., G.W.S.)
| | - Lorenzo Azzalini
- Cardiac Catheterization Laboratory, Mount Sinai Hospital, New York, NY (L.A.)
| | - J Aaron Grantham
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.G.)
| | | | - Kambis Mashayekhi
- Department of Cardiology and Angiology II University Heart Center (K.M.), Freiburg, Bad Krozingen, Germany
| | - James C Spratt
- St George's University Hospital NHS Trust, London, United Kingdom (J.C.S.)
| | - Harindra C Wijeysundera
- Schulich Heart Center, Sunnybrook Research Institute, and Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, and Institute for Health Policy, Management, and Evaluation (H.C.W.), University of Toronto, Ontario, Canada
| | - Ziad A Ali
- New York-Presbyterian Hospital/Columbia University Medical Center, NY (D.K., Z.A.A., A.M., J.W.M.).,The Cardiovascular Research Foundation, New York, NY (D.K., A.M., Z.A.A., J.W.M., G.W.S.)
| | | | - Mauro Carlino
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy (M.C.)
| | - David J Cohen
- Baim Institute for Clinical Research, Boston, MA (D.J.C., C.M.G.)
| | | | - Tony De Martini
- Southern Illinois University School of Medicine, Memorial Medical Center, Springfield, IL (T.D.M.)
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy (C.D.M.)
| | - Andrew Farb
- Department of Cardiovascular Pathology, CVPath Institute, Gaithersburg, MD (A.F., R.V.).,School of Medicine, University of Maryland, Baltimore (A.F.)
| | - Aloke V Finn
- US Food and Drug Administration, Silver Spring, MD (A.V.F., P.F.A.M.)
| | - Alfredo R Galassi
- Cardiology, Department of PROMISE, University of Palermo, Italy (A.R.G.)
| | - C Michael Gibson
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.J.C., C.M.G.)
| | - Colm Hanratty
- Belfast Health and Social Care Trust, United Kingdom (C.H.)
| | | | - Farouc A Jaffer
- Cardiology Division, Massachusetts General Hospital, Boston (F.A.J.)
| | - Mitchell W Krucoff
- Duke Clinical Research Institute and Duke University Medical Center, Durham, NC (M.W.K.)
| | | | - Akiko Maehara
- New York-Presbyterian Hospital/Columbia University Medical Center, NY (D.K., Z.A.A., A.M., J.W.M.).,The Cardiovascular Research Foundation, New York, NY (D.K., A.M., Z.A.A., J.W.M., G.W.S.)
| | - P F Adrian Magee
- US Food and Drug Administration, Silver Spring, MD (A.V.F., P.F.A.M.)
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M., G.W.S.)
| | - Jeffrey W Moses
- New York-Presbyterian Hospital/Columbia University Medical Center, NY (D.K., Z.A.A., A.M., J.W.M.).,The Cardiovascular Research Foundation, New York, NY (D.K., A.M., Z.A.A., J.W.M., G.W.S.)
| | | | - Yoshinobu Onuma
- Cardialysis Clinical Trials Management and Core Laboratories, Rotterdam, the Netherlands (Y.O.).,Department of Cardiology, National University of Ireland Galway, United Kingdom (Y.O.)
| | | | - Satoru Sumitsuji
- Division of Cardiology for International Education and Research, Osaka University Graduate School of Medicine, Suita, Japan (S.S.)
| | | | - Renu Virmani
- Department of Cardiovascular Pathology, CVPath Institute, Gaithersburg, MD (A.F., R.V.)
| | - Simon J Walsh
- Belfast Health and Social Care Trust, United Kingdom. Medizinische Klinik I Klinikum Darmstadt GmbH, Germany (S.J.W.)
| | | | | | - Gregg W Stone
- The Cardiovascular Research Foundation, New York, NY (D.K., A.M., Z.A.A., J.W.M., G.W.S.).,Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M., G.W.S.)
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8
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Predictors of Cumulative Health Care Costs Associated With Transcatheter Aortic Valve Replacement in Severe Aortic Stenosis. Can J Cardiol 2020; 36:1244-1251. [DOI: 10.1016/j.cjca.2019.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/04/2019] [Accepted: 12/08/2019] [Indexed: 11/23/2022] Open
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9
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Tam DY, Azizi PM, Fremes SE, Chikwe J, Gaudino M, Wijeysundera HC. The cost-effectiveness of transcatheter aortic valve replacement in low surgical risk patients with severe aortic stenosis. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 7:556-563. [DOI: 10.1093/ehjqcco/qcaa058] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
The economic value of transcatheter aortic valve replacement (TAVR) in low surgical risk patients with severe, symptomatic aortic stenosis is not known. Our objective was to determine the cost-effectiveness of balloon-expandable TAVR and self-expandable TAVR relative to surgical aortic valve replacement (SAVR) in low-risk patients.
Methods and results
A fully probabilistic Markov cohort model was constructed to estimate differences in costs and effectiveness [quality-adjusted life years (QALYs)] over the patient’s life-time time from the third-party payer’s perspective. Clinical outcomes modelled were alive/well (no complications), permanent stroke, ≥moderate paravalvular leak, new pacemaker, rehospitalization, and death. A network meta-analysis of the PARTNER 3 and Evolut Low Risk trial was performed to compare balloon-expandable TAVR, self-expandable TAVR, and SAVR for the efficacy inputs. Incremental-cost effectiveness ratios (ICER) were calculated. The total life-time costs in the balloon-expandable TAVR, self-expandable-TAVR, and SAVR arms were $37 330 ± 4724, $39 660 ± 4862, and $34 583 ± 6731, respectively, and total life-time QALYs gained were 9.15 ± 3.23, 9.13 ± 3.23, and 9.05 ± 3.20, respectively. The ICERs for balloon-expandable TAVR and self-expandable TAVR against SAVR were $27 196/QALY and $59 641/QALY, respectively. Balloon-expandable TAVR was less costly and more effective than self-expandable TAVR. There was substantial uncertainty, with 53% and 58% of model iterations showing balloon-expandable TAVR to be the preferred option at willingness-to-pay thresholds of $50 000/QALY and $100 000/QALY, respectively.
Conclusion
Compared with SAVR, TAVR, particularly with balloon-expandable prostheses may be a cost-effective option for patients with severe aortic stenosis at low surgical risk.
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Affiliation(s)
- Derrick Y Tam
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Paymon M Azizi
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Stephen E Fremes
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Joanna Chikwe
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York—Presbyterian Hospital, New York, NY, USA
| | - Harindra C Wijeysundera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Division of Cardiology, Department of Medicine, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room A202, Toronto, ON M4N 3M5, Canada
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10
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Wijeysundera HC, Henning KA, Qiu F, Adams C, Al Qoofi F, Asgar A, Austin P, Bainey KR, Cohen EA, Daneault B, Fremes S, Kass M, Ko DT, Lambert L, Lauck SB, MacFarlane K, Nadeem SN, Oakes G, Paddock V, Pelletier M, Peterson M, Piazza N, Potter BJ, Radhakrishnan S, Rodes-Cabau J, Toleva O, Webb JG, Welsh R, Wood D, Woodward G, Zimmermann R. Inequity in Access to Transcatheter Aortic Valve Replacement: A Pan-Canadian Evaluation of Wait-Times. Can J Cardiol 2020; 36:844-851. [DOI: 10.1016/j.cjca.2019.10.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/13/2019] [Accepted: 10/21/2019] [Indexed: 01/03/2023] Open
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11
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Goldsweig AM, Tak HJ, Chen LW, Aronow HD, Shah B, Kolte D, Desai NR, Szerlip M, Velagapudi P, Abbott JD. Relative Costs of Surgical and Transcatheter Aortic Valve Replacement and Medical Therapy. Circ Cardiovasc Interv 2020; 13:e008681. [DOI: 10.1161/circinterventions.119.008681] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The number of patients treated for aortic valve disease in the United States is increasing rapidly. Transcatheter aortic valve replacement (TAVR) is supplanting surgical aortic valve replacement (SAVR) and medical therapy (MT). The economic implications of these trends are unknown. Therefore, we undertook to determine the costs, inpatient days, and number of admissions associated with treating aortic valve disease with SAVR, TAVR, or MT.
Methods:
Using the Nationwide Readmissions Database, we identified patients with aortic valve disease admitted 2012 to 2016 for SAVR, TAVR, and disease symptoms (congestive heart failure, unstable angina, non–ST-elevation myocardial infarction, syncope). Patients not undergoing SAVR or TAVR were classified as receiving MT. Beginning with the index admission, we estimated inpatient costs, days, and admissions over 6 months.
Results:
Among 190 563 patients with aortic valve disease, the average aggregate 6-month inpatient costs were $59 743 for SAVR, $64 395 for TAVR, and $23 460 for MT. Mean index admission was longer for SAVR (10.0 days) than for TAVR (7.0 day) or MT (5.3 days), but the average number of unplanned readmission inpatient days was 2.0 for SAVR, 3.0 for TAVR, and 4.3 for MT; the average number of total admissions was 1.3 for SAVR, 1.5 for TAVR, and 1.7 for MT (
P
<0.01 for all). TAVR index admission costs decreased over time to become similar to SAVR costs by 2016.
Conclusions:
Aggregate costs were higher for TAVR than SAVR and were significantly more expensive than MT alone. However, TAVR costs decreased over time while SAVR and MT costs remained unchanged.
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Affiliation(s)
- Andrew M. Goldsweig
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha. (A.M.G., P.V.)
| | - Hyo Jung Tak
- Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha. (H.J.T., L.-W.C.)
| | - Li-Wu Chen
- Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha. (H.J.T., L.-W.C.)
| | - Herbert D. Aronow
- Division of Cardiovascular Medicine, Lifespan Cardiovascular Institute, Brown University, Providence, RI (H.D.A., J.D.A.)
| | - Binita Shah
- Division of Cardiology, VA New York Harbor Healthcare and New York University School of Medicine (B.S.)
| | - Dhaval Kolte
- Division of Cardiovascular Medicine, Harvard University, Massachusetts General Hospital, Boston (D.K.)
| | - Nihar R. Desai
- Division of Cardiovascular Medicine, Yale University, Yale New Haven Hospital, New Haven, CT (N.R.D.)
| | - Molly Szerlip
- Department of Interventional Cardiology, The Heart Hospital, Baylor Plano, Plano, TX (M.S.)
| | - Poonam Velagapudi
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha. (A.M.G., P.V.)
| | - J. Dawn Abbott
- Division of Cardiovascular Medicine, Lifespan Cardiovascular Institute, Brown University, Providence, RI (H.D.A., J.D.A.)
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Okoh AK, Haik N, Haik B, Gold J, Chen C, Lee LY, Cohen M, Russo MJ. Periprocedural Complications After Transcatheter Aortic Valve Replacement and Their Impact on Resource Utilization. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1086-1090. [PMID: 32046925 DOI: 10.1016/j.carrev.2020.01.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/11/2019] [Accepted: 01/31/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND To examine the incidence and trends of peri-procedural complications after TAVR and their impact on resource utilization. METHODS The incidence of complications by type [acute kidney injury (AKI), permanent pacemaker (PPM), vascular, paravalvular leak, in-hospital mortality, others] was calculated for TAVR patients at a high-volume center between 2012 and 2018. Clinical data were matched with hospital-billing data of patients. Trends in high resource utilization (discharge to a rehabilitation facility or PLOS >7 days) (HRU) and complication rates were assessed. Multivariable logistic regression models were used to determine predictors of HRU. RESULTS Out of 1163 patients, 966 (83%) had no complications, others in 95 (8%), PPM in 56 (5%), AKI alone in 32 (3%), vascular in 31 (3%), in-hospital mortality in 28 (2%) and PVL in 10 (1%). A significant decreasing trend in the incidence of complications (29% vs 10%; p trend <0.001) and HRU (75% vs 12%; p trend <0.001) was observed between 2012 and 2018 respectively. Mean ± SD direct procedure cost of having a complication was $58,234 ± $24,568, was associated with an incremental cost of $10, 649 and a prolonged stay of 3-days. On multivariable logistic regression analysis, PPM, vascular complications, high STS risk score, NYHA class III/IV, frailty and ≥ moderate tricuspid regurgitation were significantly associated with HRU. TAVR year was protective against HRU. CONCLUSIONS We established that, post-TAVR resource utilization and morbidity is high among frail and patients with higher STS risk scores. However, these rates decrease over time with experience.
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Affiliation(s)
- Alexis K Okoh
- Cardiovascular Research Unit, RWJ Barnabas Health, NBIMC, Newark, NJ, United States of America.
| | - Nicky Haik
- Cardiovascular Research Unit, RWJ Barnabas Health, NBIMC, Newark, NJ, United States of America
| | - Bruce Haik
- Cardiovascular Research Unit, RWJ Barnabas Health, NBIMC, Newark, NJ, United States of America
| | - Justin Gold
- Cardiovascular Research Unit, RWJ Barnabas Health, NBIMC, Newark, NJ, United States of America
| | - Chunguang Chen
- Cardiovascular Research Unit, RWJ Barnabas Health, NBIMC, Newark, NJ, United States of America
| | - Leonard Y Lee
- Rutgers/Robert Wood Johnson University Hospital, New Brunswick, NJ, United States of America
| | - Marc Cohen
- Cardiovascular Research Unit, RWJ Barnabas Health, NBIMC, Newark, NJ, United States of America
| | - Mark J Russo
- Cardiovascular Research Unit, RWJ Barnabas Health, NBIMC, Newark, NJ, United States of America; Rutgers/Robert Wood Johnson University Hospital, New Brunswick, NJ, United States of America
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13
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Modi PK, Sukul DA, Oerline M, Thompson MP, Nallamothu BK, Ellimoottil C, Shahinian VB, Hollenbeck BK. Episode Payments for Transcatheter and Surgical Aortic Valve Replacement. Circ Cardiovasc Qual Outcomes 2019; 12:e005781. [PMID: 31830824 DOI: 10.1161/circoutcomes.119.005781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Aortic stenosis is the most common valvular heart disease in the United States. Transcatheter aortic valve replacement (TAVR) is increasingly being adopted as an alternative to surgical aortic valve replacement (SAVR). In an era of value-based payment reform, our objective was to better understand the economic impact of the use of TAVR and SAVR in the United States. METHODS AND RESULTS We performed a retrospective cohort study of Medicare beneficiaries who underwent TAVR or SAVR between 2012 and 2015. Using claims from a 20% sample of national fee-for-service Medicare beneficiaries, we calculated episode payments for patients who underwent aortic valve replacement from 90 days before aortic valve replacement through 90 days after hospital discharge. Among 18 804 eligible patients, 6455 underwent TAVR (34.3%), and 12 349 underwent SAVR (65.7%). After adjustment for patient characteristics, episode payments for TAVR were ≈7% lower than for SAVR (TAVR, $55 545 [95% CI, $54 643-56 446] versus $59 467 [95% CI, $58 723-60 211]; P<0.001). Patients with TAVR had higher preprocedural payments, but lower payments during and after the index hospitalization for the procedure. Episode payments increased with increasing comorbidity score for patients undergoing TAVR or SAVR (rate ratio, 1.16 [95% CI, 1.15-1.17]; P<0.001); however, this association was stronger for SAVR (rate ratio, 1.18 [95% CI, 1.17-1.19]) than for TAVR (rate ratio, 1.11 [95% CI, 1.11-1.12]; P<0.001 for interaction). Thus, differences in episode payments between TAVR and SAVR were greatest for the sickest patients but much less in healthier patients. CONCLUSIONS TAVR is associated with lower episode payments than SAVR. However, episode payments for TAVR are less influenced by patient comorbidity. Therefore, as TAVR is increasingly used in patients with better baseline health status, the economic advantages of TAVR relative to SAVR may diminish.
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Affiliation(s)
- Parth K Modi
- Dow Division of Health Services Research, Department of Urology (P.K.M., M.O., C.E., V.B.S., B.K.H.), University of Michigan, Ann Arbor
| | - Devraj A Sukul
- Division of Cardiovascular Diseases, Department of Internal Medicine (D.A.S., B.K.N.), University of Michigan, Ann Arbor
| | - Mary Oerline
- Dow Division of Health Services Research, Department of Urology (P.K.M., M.O., C.E., V.B.S., B.K.H.), University of Michigan, Ann Arbor
| | - Michael P Thompson
- Department of Cardiac Surgery (M.P.T.), University of Michigan, Ann Arbor
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Diseases, Department of Internal Medicine (D.A.S., B.K.N.), University of Michigan, Ann Arbor
| | - Chad Ellimoottil
- Dow Division of Health Services Research, Department of Urology (P.K.M., M.O., C.E., V.B.S., B.K.H.), University of Michigan, Ann Arbor
| | - Vahakn B Shahinian
- Dow Division of Health Services Research, Department of Urology (P.K.M., M.O., C.E., V.B.S., B.K.H.), University of Michigan, Ann Arbor.,Division of Nephrology, Department of Internal Medicine (V.B.S.), University of Michigan, Ann Arbor
| | - Brent K Hollenbeck
- Dow Division of Health Services Research, Department of Urology (P.K.M., M.O., C.E., V.B.S., B.K.H.), University of Michigan, Ann Arbor
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14
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Witberg G, Shamekhi J, Van Mieghem NM, Ferrero-Guadagnoli A, Soendergaard L, Dvir D, Latib A, Testa L, Guerrero M, Piazza N, Bleiziffer S, Webb JG, Barbash I, Finkelstein A, Makkar R, Mylotte D, Sinning JM, El Faquir N, Masiano F, De Backer O, Birs A, Lanzillo G, Bedogni F, Iftikhar O, Pighi M, Deutsch MA, Attinger-Toller A, Maor E, Rozenbaum Z, Yoon SH, Neylon A, Kornowski R. Transcatheter Aortic Valve Replacement Outcomes in Patients With Native vs Transplanted Kidneys: Data From an International Multicenter Registry. Can J Cardiol 2019; 35:1114-1123. [DOI: 10.1016/j.cjca.2019.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 10/27/2022] Open
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15
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Goldsweig AM, Tak HJ, Chen LW, Aronow HD, Shah B, Kolte DS, Velagapudi P, Desai N, Szerlip M, Abbott JD. The Evolving Management of Aortic Valve Disease: 5-Year Trends in SAVR, TAVR, and Medical Therapy. Am J Cardiol 2019; 124:763-771. [PMID: 31277791 DOI: 10.1016/j.amjcard.2019.05.044] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/13/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
Abstract
Aortic stenosis (AS) and regurgitation (AR) may be treated with surgical aortic valve replacement (SAVR), transcatheter AVR (TAVR), or medical therapy (MT). Data are lacking regarding the usage of SAVR, TAVR, and MT for patients hospitalized with aortic valve disease and the characteristics of the patients and hospitals associated with each therapy. From the Nationwide Readmissions Database, we determined utilization trends for SAVR, TAVR, and MT in patients with aortic valve disease admitted from 2012 to 2016 for valve replacement, heart failure, unstable angina, non-ST-elevation myocardial infarction, or syncope. We also performed multinomial logistic regressions to investigate associations between patient and hospital characteristics and treatment. Among 366,909 patients hospitalized for aortic valve disease, there was a 48.1% annual increase from 2012 through 2016. Overall, 19.9%, 6.7%, and 73.4% of patients received SAVR, TAVR, and MT, respectively. SAVR decreased from 21.9% in 2012 to 18.5% in 2016, whereas TAVR increased from 2.6% to 12.5%, and MT decreased from 75.5% to 69.0%. Older age, female sex, greater severity of illness, more admission diagnoses, not-for-profit hospitals, large hospitals, and urban teaching hospitals were associated with greater use of TAVR. In multivariable analysis, likelihood of TAVR relative to SAVR increased 4.57-fold (95% confidence interval 4.21 to 4.97). TAVR has increased at the expense of both SAVR and MT, a novel finding. However, this increase in TAVR was distributed inequitably, with certain patients more likely to receive TAVR certain hospitals more likely to provide TAVR. With the expected expansion of indications, inequitable access to TAVR must be addressed.
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16
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Lauck SB, Baron SJ, Sathananthan J, Murdoch D, Webb JG, Genereux P, Kodali SK, Reynolds M, Thompson C, Clancy S, Thourani VH, Wood DA, Cohen DJ. Exploring the Reduction in Hospitalization Costs Associated with Next-Day Discharge following Transfemoral Transcatheter Aortic Valve Replacement in the United States. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2019. [DOI: 10.1080/24748706.2019.1634854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Sandra B. Lauck
- Department of Cardiology, Centre for Heart Valve Innovation, St. Paul’s Hospital, Vancouver, BC, Canada
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Suzanne J. Baron
- Department of Internal Medicine, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA
| | - Janarthanan Sathananthan
- Department of Cardiology, Centre for Heart Valve Innovation, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Dale Murdoch
- Department of Cardiology, Centre for Heart Valve Innovation, St. Paul’s Hospital, Vancouver, BC, Canada
| | - John G. Webb
- Department of Cardiology, Centre for Heart Valve Innovation, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Philippe Genereux
- Interventional Cardiology, Morristown Medical Center, Morristown, New Jersey, USA
| | - Susheel K. Kodali
- Structural Heart & Valve Center, New York Presbyterian, Columbia University Medical Center, New York, New York, USA
| | - Matthew Reynolds
- Department of Clinical Research, Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | | | - Seth Clancy
- Edwards LifeSciences, Irvine, California, USA
| | - Vinod H. Thourani
- Department of Cardiac Surgery, Medstar Heart Institute/Washington Hospital Center, Washington, DC, USA
| | - David A. Wood
- Department of Cardiology, Centre for Heart Valve Innovation, St. Paul’s Hospital, Vancouver, BC, Canada
| | - David J. Cohen
- Department of Internal Medicine, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA
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17
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Nazzari H, Hawkins NM, Ezekowitz J, Lauck S, Ding L, Polderman J, Yu M, Boone RH, Cheung A, Ye J, Wood D, Webb J, Toma M. The Relationship Between Heart-Failure Hospitalization and Mortality in Patients Receiving Transcatheter Aortic Valve Replacement. Can J Cardiol 2018; 35:413-421. [PMID: 30853134 DOI: 10.1016/j.cjca.2018.11.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Patients who have had transcatheter aortic valve replacement (TAVR) are at risk of hospitalization during the first year postprocedure. Few studies have examined the incidence of heart- failure hospitalizations (HFH) post-TAVR and the impact this has on subsequent hospitalizations and mortality. Our aim was to determine the incidence, predictors, and mortality associated with HFH post-TAVR. METHODS We used prospectively collected data for all patients who underwent TAVR between August 1, 2010, and March 31, 2015; 742 consecutive patients who underwent TAVR during the study period were included. Patients were followed for a minimum of 1 year post-TAVR. RESULTS Mean age was 80.9 ± 8.1, and 58.2% were men. Hospitalizations post-TAVR occurred in 20% of patients at 30 days and 59.7% at 1 year. Of patients hospitalized, HFH was the primary cause of hospitalization in 25.8% and 21.4% of patients at 30 days and 1 year post-TAVR, respectively. Patients with HFH at either 30 days or 1 year had higher subsequent rates of rehospitalization compared with patients who had non-HFH. Patients with HFH or non-HFH at 30 days had 1-year mortality rates of 23.1% and 21.4%, respectively, whereas those with HFH by 1 year had a higher 1-year rate of mortality compared with patients who had non-HFHs (25% vs 10.9%, P < 0.001). CONCLUSIONS HF accounts for a quarter of all hospitalizations post-TAVR and is associated with higher rates of subsequent rehospitalization and death compared with those who had non-HFH. Understanding predictors of readmissions post-TAVR will allow for better risk stratification and improve outcomes in patients receiving TAVR.
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Affiliation(s)
- Hamed Nazzari
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathaniel M Hawkins
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Justin Ezekowitz
- Department of Medicine and the Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Sandra Lauck
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lillian Ding
- Cardiac Services British Columbia, Vancouver, British Columbia, Canada
| | - Jopie Polderman
- Cardiac Services British Columbia, Vancouver, British Columbia, Canada
| | - Maggie Yu
- Cardiac Services British Columbia, Vancouver, British Columbia, Canada
| | - Robert H Boone
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anson Cheung
- Division of Cardiovascular Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jian Ye
- Division of Cardiovascular Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Wood
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - John Webb
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mustafa Toma
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
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18
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Tam DY, Hughes A, Wijeysundera HC, Fremes SE. Cost and effectiveness: Can't have one without the other. J Thorac Cardiovasc Surg 2018; 156:1851-1853. [PMID: 30336914 DOI: 10.1016/j.jtcvs.2018.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 05/10/2018] [Accepted: 05/10/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Derrick Y Tam
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Avery Hughes
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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19
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Percutaneous Direct Annuloplasty With Edge-to-Edge Technique for Mitral Regurgitation: Replicating a Complete Surgical Mitral Repair in a One-Step Procedure. Can J Cardiol 2018; 34:1088.e1-1088.e2. [DOI: 10.1016/j.cjca.2018.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 03/23/2018] [Accepted: 04/02/2018] [Indexed: 11/19/2022] Open
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20
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Tam DY, Vo TX, Wijeysundera HC, Dvir D, Friedrich JO, Fremes SE. Transcatheter valve-in-valve versus redo surgical aortic valve replacement for the treatment of degenerated bioprosthetic aortic valve: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2018; 92:1404-1411. [DOI: 10.1002/ccd.27686] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/02/2018] [Accepted: 05/15/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Derrick Y. Tam
- Division of Cardiac Surgery, Department of Surgery; Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto; Toronto Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto; Toronto Canada
| | - Thin X. Vo
- Division of Cardiac Surgery, Department of Surgery; University of Ottawa Heart Institute, University of Ottawa; Ottawa Canada
| | - Harindra C. Wijeysundera
- Institute of Health Policy, Management and Evaluation, University of Toronto; Toronto Canada
- Division of Cardiology, Department of Medicine; Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto; Toronto Canada
| | - Danny Dvir
- Division of Cardiology Department of Medicine; University of Washington Medical Centre; Seattle Washington
| | - Jan O. Friedrich
- Critical Care and Medicine Departments; St. Michael's Hospital University of Toronto; Toronto Canada
| | - Stephen E. Fremes
- Division of Cardiac Surgery, Department of Surgery; Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto; Toronto Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto; Toronto Canada
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21
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A cost-utility analysis of transcatheter versus surgical aortic valve replacement for the treatment of aortic stenosis in the population with intermediate surgical risk. J Thorac Cardiovasc Surg 2018; 155:1978-1988.e1. [DOI: 10.1016/j.jtcvs.2017.11.112] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 10/31/2017] [Accepted: 11/24/2017] [Indexed: 11/19/2022]
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22
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Minakata K. Transcatheter aortic valve replacement: Suitable for all? J Cardiol 2017; 71:221-222. [PMID: 29195788 DOI: 10.1016/j.jjcc.2017.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 11/06/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Kenji Minakata
- Division of Cardiovascular Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA.
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