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Czarnecki A, Han L, Abuzeid W, Cantor WJ, Chan V, Cohen EA, Cohen GN, Fam N, Garg P, Hibbert B, Mehta SR, Ong G, Osten M, Ko DT. Impact of Transcatheter Mitral Valve Repair on Preprocedural and Postprocedural Hospitalization Rates. JACC Cardiovasc Interv 2021; 14:2274-2281. [PMID: 34674865 DOI: 10.1016/j.jcin.2021.08.007] [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: 11/04/2020] [Revised: 07/27/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The objective of this study was to determine the effect of transcatheter mitral valve repair (TMVr) on hospitalization rates by assessing pre- and postprocedural hospitalization patterns. BACKGROUND TMVr has emerged as the treatment of choice for selected patients with mitral regurgitation, but the impact of these procedures on hospital utilization remains unclear. METHODS All patients who underwent TMVr in Ontario, Canada, between 2011 and 2017 were included in this observational study using population-based data. Hospitalization person-year rates were assessed in the years before and after TMVr and 4 predefined intervals: 1 to 30, 31 to 90, 91 to 182, and 183 to 365 days. Main outcomes of interest were all-cause and heart failure (HF) hospitalizations. Poisson regression models were used to compare incidence rates across all time periods. RESULTS The study cohort included 523 patients. In the year preceding TMVr, 66.2% of patients were hospitalized compared with 47.4% in the year following. There were stepwise increases in both all-cause and HF hospitalization rates in the periods preceding the index procedure, and all postprocedural periods had significantly lower hospitalization rates. The adjusted rate ratios for all-cause and HF-related hospitalization in the year after TMVr were 0.65 (95% CI: 0.56-0.76) and 0.38 (95% CI: 0.29-0.51), respectively. All time periods had significant reductions in all-cause and HF hospitalization in the adjusted analysis. CONCLUSIONS In this population-based study, significant reductions were observed in both all-cause and HF-related hospitalizations in all time periods after TMVr compared with the year prior. This suggests that TMVr has a sustained effect on hospitalization rates despite a high-risk population.
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Affiliation(s)
- Andrew Czarnecki
- ICES, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Lu Han
- ICES, Toronto, Ontario, Canada
| | - Wael Abuzeid
- Kingston General Hospital, Kingston, Ontario, Canada
| | - Warren J Cantor
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | | | - Eric A Cohen
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gideon N Cohen
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Neil Fam
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital, Toronto, Ontario, Canada
| | - Pallav Garg
- London Health Sciences Centre, London, Ontario, Canada
| | | | - Shamir R Mehta
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Geraldine Ong
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital, Toronto, Ontario, Canada
| | - Mark Osten
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Dennis T Ko
- ICES, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Kalbacher D, Schofer N. Reducing Rehospitalization Rates by Transcatheter Mitral Edge-to-Edge Repair: A Matter of Quality of Life. JACC Cardiovasc Interv 2021; 14:2282-2284. [PMID: 34674866 DOI: 10.1016/j.jcin.2021.08.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Daniel Kalbacher
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Lübeck/Kiel, Lübeck, Germany.
| | - Niklas Schofer
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Alkhouli M, Sulaiman S, Osman M, El Shaer A, Mayahni AA, Kawsara A. Trends in outcomes, cost, and readmissions of transcatheter edge to edge repair in the United States (2014-2018). Catheter Cardiovasc Interv 2021; 99:949-955. [PMID: 34520618 DOI: 10.1002/ccd.29957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 08/09/2021] [Accepted: 09/06/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Despite the growth in transcatheter edge-to-edge repair (TEER) volume in the United States, data on the temporal changes in procedural outcomes are lacking. METHODS We utilized the National Readmission Database to assess the annual changes in patient's characteristics, in-hospital outcomes, cost, and readmissions for patients who underwent TEER between January 1, 2014 and December 31, 2018. Outcomes of interest included mortality, major adverse cardiovascular events (MACE) and any adverse event (AE). We also assessed length of stay and cost. RESULTS A total of 22,692 hospitalizations were included. The mean age increased from 75.2 ± 12.9 in 2014 to 78.1 ± 9.8 years in 2018. Changes in the prevalence of risk factors were heterogenous. The incidence of in-hospital mortality decreased from 4.0% in 2014 to 2.0% in 2018. Both MACE and any AE decreased significantly. Although the incidence of 30-day readmission remained stable, there was a trend towards a temporal increase in both 90-day and 180-day. The adjusted median length of stay of the index admission decreased by 50% and this trend was associated with a $2100 reduction in risk and inflation adjusted in-hospital cost, however, this reduction was offset by the increased total cost of readmissions within the first 6 months resulting in similar net-cost. CONCLUSION The volume of TEER has grown substantially between 2014 and 2018 coupled with a temporal improvement in in-hospital outcomes and reduction in cost and length of stay. Re-hospitalization rates after TEER remained steady at 30-day and trended towards worsening overtime at 90- and 180-days.
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Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Samian Sulaiman
- Division of Cardiology, Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Mohammed Osman
- Division of Cardiology, Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Ahmed El Shaer
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Abdulah Amer Mayahni
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Akram Kawsara
- Division of Cardiology, Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
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Wijeysundera HC, Sud M. One Step Forward, Two Back: Is Noncardiovascular Rehospitalization the QI Metric in Transcatheter Interventions? JACC Cardiovasc Interv 2019; 12:2427-2429. [PMID: 31734297 DOI: 10.1016/j.jcin.2019.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 10/01/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Harindra C Wijeysundera
- Schulich Heart Center, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Maneesh Sud
- Schulich Heart Center, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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