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March 29, 2020

Composite Metric Developed to Benchmark Site Performance in TAVR

March 29, 2020—The American College of Cardiology (ACC) announced that findings on a composite metric for benchmarking site performance in transcatheter aortic valve replacement (TAVR) were presented by Nimesh Desai, MD, at the virtual conference of the ACC's Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC).

As summarized by ACC, the investigators analyzed data for 2015, 2016, and 2017 from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (STS/ACC TVT) Registry.

The STS/ACC TVT registry includes approximately all patients who undergo TAVR in the United States. From there, they created a model to assess serious complications that patients would likely want to consider when making decisions about a TAVR procedure.

In addition to mortality, the investigators identified four key outcomes that can significantly impact patients’ quality of life a year after a TAVR procedure: stroke, life-threatening or disabling bleeding, stage three acute kidney injury, and moderate or severe paravalvular leak. The outcomes were ranked according to their impact on a patient’s daily functioning and quality of life.

Applying the metric to the STS/ACC TVT registry data, they identified the average in-hospital complication rate across all sites and categorized sites whose outcomes were outside 95% confidence intervals of that average as performing better or worse than expected. Because it incorporates multiple outcomes on a ranked basis, the model was found to generate reliable assessments even when including sites performing a low volume of TAVR procedures per year.

The ACC reported that the study assessed outcomes in 54,217 patients treated at the 301 medical centers that perform TAVR in the United States, of which 11% saw worse-than-expected outcomes in terms of survival and quality of life among patients undergoing the procedure; 80% had an as-expected rate of in-hospital complications; and 8% had better-than-expected complication rates. Investigators found a substantial difference in complication rates among sites with worse-than-expected performance and those with better-than-expected performance.

In the ACC press release, Dr. Desai commented, “There’s clearly an opportunity to improve processes and try to better standardize care to decrease variation between different sites. The overarching goal of this work is to provide transparency to the public and also to provide feedback to sites so that they can review their practices and develop ways to improve the results in their patients.”

He continued, “We wanted to develop a way of assessing quality using endpoints that are very important to patients. Among registries for major cardiovascular procedures, this is the first metric to incorporate the patient’s functional status and quality of life, both in the risk assessment of the patient and in the derivation of the outcome measures.”

The investigators plan to further analyze the data to identify any features or factors that may be associated with worse than expected performance. In addition, the model can help establish a platform for public reporting that patients and hospitals could use to inform decision-making, stated Dr. Desai in the ACC announcement.

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