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Oseran AS, Sun T, Wadhera RK, Dahabreh IJ, de Lemos JA, Das SR, Rutan C, Asnani AH, Yeh RW, Kazi DS. Enriching the American Heart Association COVID-19 Cardiovascular Disease Registry Through Linkage With External Data Sources: Rationale and Design. J Am Heart Assoc 2022; 11:e7743. [PMID: 36102226 PMCID: PMC9683646 DOI: 10.1161/jaha.122.027094] [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 The AHA Registry (American Heart Association COVID-19 Cardiovascular Disease Registry) captures detailed information on hospitalized patients with COVID-19. The registry, however, does not capture information on social determinants of health or long-term outcomes. Here we describe the linkage of the AHA Registry with external data sources, including fee-for-service (FFS) Medicare claims, to fill these gaps and assess the representativeness of linked registry patients to the broader Medicare FFS population hospitalized with COVID-19. Methods and Results We linked AHA Registry records of adults ≥65 years from March 2020 to September 2021 with Medicare FFS claims using a deterministic linkage algorithm and with the American Hospital Association Annual Survey, Rural Urban Commuting Area codes, and the Social Vulnerability Index using hospital and geographic identifiers. We compared linked individuals with unlinked FFS beneficiaries hospitalized with COVID-19 to assess the representativeness of the AHA Registry. A total of 10 010 (47.0%) records in the AHA Registry were successfully linked to FFS Medicare claims. Linked and unlinked FFS beneficiaries were similar with respect to mean age (78.1 versus 77.9, absolute standardized difference [ASD] 0.03); female sex (48.3% versus 50.2%, ASD 0.04); Black race (15.1% versus 12.0%, ASD 0.09); dual-eligibility status (26.1% versus 23.2%, ASD 0.07); and comorbidity burden. Linked patients were more likely to live in the northeastern United States (35.7% versus 18.2%, ASD 0.40) and urban/metropolitan areas (83.9% versus 76.8%, ASD 0.18). There were also differences in hospital-level characteristics between cohorts. However, in-hospital outcomes were similar (mortality, 23.3% versus 20.1%, ASD 0.08; home discharge, 45.5% versus 50.7%, ASD 0.10; skilled nursing facility discharge, 24.4% versus 22.2%, ASD 0.05). Conclusions Linkage of the AHA Registry with external data sources such as Medicare FFS claims creates a unique and generalizable resource to evaluate long-term health outcomes after COVID-19 hospitalization.
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Affiliation(s)
- Andrew S. Oseran
- Richard A. and Susan F. Smith Center for Outcomes ResearchBeth Israel Deaconess Medical CenterBostonMA,Division of CardiologyMassachusetts General Hospital and Harvard Medical SchoolBostonMA
| | - Tianyu Sun
- Richard A. and Susan F. Smith Center for Outcomes ResearchBeth Israel Deaconess Medical CenterBostonMA
| | - Rishi K. Wadhera
- Richard A. and Susan F. Smith Center for Outcomes ResearchBeth Israel Deaconess Medical CenterBostonMA,Division of CardiologyBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMA
| | - Issa J. Dahabreh
- Richard A. and Susan F. Smith Center for Outcomes ResearchBeth Israel Deaconess Medical CenterBostonMA,CAUSALabHarvard T.H. Chan School of Public HealthBostonMA,Departments of Epidemiology and BiostatisticsHarvard T.H. Chan School of Public HealthBostonMA
| | - James A. de Lemos
- Division of CardiologyUniversity of Texas Southwestern Medical CenterDallasTX
| | - Sandeep R. Das
- Division of CardiologyUniversity of Texas Southwestern Medical CenterDallasTX
| | - Christine Rutan
- Quality, Outcomes Research and AnalyticsAmerican Heart AssociationDallasTX
| | - Aarti H. Asnani
- Division of CardiologyBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMA
| | - Robert W. Yeh
- Richard A. and Susan F. Smith Center for Outcomes ResearchBeth Israel Deaconess Medical CenterBostonMA,Division of CardiologyBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMA
| | - Dhruv S. Kazi
- Richard A. and Susan F. Smith Center for Outcomes ResearchBeth Israel Deaconess Medical CenterBostonMA,Division of CardiologyBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMA
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Kaneko T, Hirji SA, Yazdchi F, Sun YP, Nyman C, Shook D, Cohen DJ, Stebbins A, Zeitouni M, Vemulapalli S, Thourani VH, Shah PB, O'Gara P. Association Between Peripheral Versus Central Access for Alternative Access Transcatheter Aortic Valve Replacement and Mortality and Stroke: A Report From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Circ Cardiovasc Interv 2022; 15:e011756. [PMID: 36126131 DOI: 10.1161/circinterventions.121.011756] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In some patients, the alternative access route for transcatheter aortic valve replacement (TAVR) is utilized because the conventional transfemoral approach is not felt to be either feasible or optimal. However, accurate prognostication of patient risks is not well established. This study examines the associations between peripheral (transsubclavian/transaxillary, and transcarotid) versus central access (transapical and transaortic) in alternative access TAVR and 30-day and 1-year end points of mortality and stroke for all valve platforms. METHODS Using data from The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry with linkage to Medicare claims, patients who underwent alternative access TAVR from June 1, 2015 to June 30, 2018 were identified. Adjusted and unadjusted Cox proportional hazards modeling were performed to determine the association between alternate access TAVR site and 30-day and 1-year end points of mortality and stroke. RESULTS Of 7187 alternative access TAVR patients, 3725 (52%) had peripheral access and 3462 (48%) had central access. All-cause mortality was significantly lower in peripheral access versus central access group at in-hospital and 1 year (2.9% versus 6.3% and 20.3% versus 26.6%, respectively), but stroke rates were higher (5.0% versus 2.8% and 7.3% versus 5.5%, respectively; all P<0.001). These results persisted after 1-year adjustment (death adjusted hazard ratio, 0.72 [95% CI, 0.62-0.85] and stroke adjusted hazard ratio, 2.92 [95% CI, 2.21-3.85]). When broken down by individual subtypes, compared with transaxillary/subclavian access patients, transapical, and transaortic access patients had higher all-cause mortality but less stroke (P<0.05). CONCLUSIONS In this real-world, contemporary, nationally representative benchmarking study of alternate access TAVR sites, peripheral access was associated with favorable mortality and morbidity outcomes compared with central access, at the expense of higher stroke. These findings may allow for accurate prognostication of risk for patient counseling and decision-making for the heart team with regard to alternative access TAVR.
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Affiliation(s)
- Tsuyoshi Kaneko
- Division of Thoracic and Cardiac Surgery (T.K., S.H., F.Y.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sameer A Hirji
- Division of Thoracic and Cardiac Surgery (T.K., S.H., F.Y.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Farhang Yazdchi
- Division of Thoracic and Cardiac Surgery (T.K., S.H., F.Y.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Yee-Ping Sun
- Division of Cardiovascular Medicine (Y.P.S., P.S., P.O.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Charles Nyman
- Division of Cardiac Anesthesia (C.N., D.S.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Douglas Shook
- Division of Cardiac Anesthesia (C.N., D.S.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David J Cohen
- Cardiovascular Research Foundation, New York, NY (D.J.C.).,Duke Clinical Research Institute, Durham, NC (D.J.C.)
| | | | | | | | | | - Pinak B Shah
- Division of Cardiovascular Medicine (Y.P.S., P.S., P.O.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Patrick O'Gara
- Division of Cardiovascular Medicine (Y.P.S., P.S., P.O.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Shahim B, Cohen DJ. Transporting Results of TAVR Trials to the Real World: A Long and Winding Road. JACC Cardiovasc Interv 2021; 14:2124-2126. [PMID: 34620390 DOI: 10.1016/j.jcin.2021.08.029] [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: 08/10/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Bahira Shahim
- Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - David J Cohen
- Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA.
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