Study Evaluates Hospital Resource Utilization Before and After TAVR

March 12, 2019—Findings from a study that sought to assess the effect of transcatheter aortic valve replacement (TAVR) on hospitalizations for patients with severe aortic stenosis (AS) were published by Sreekanth Vemulapalli, MD, et al in Journal of the American College of Cardiology (JACC; 2019;73:1135–1146).

As summarized in JACC, the investigators used data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (TVT) registry with linkage to Medicare claims to examine rates of all-cause, cardiovascular, and noncardiovascular hospitalizations and hospital days, as well as inpatient costs in the year pre-TAVR and post-TAVR. Multivariable modeling was used to determine rate ratios of post-TAVR versus pre-TAVR hospitalizations and costs.

The investigators concluded in JACC that patients had lower costs and fewer heart failure hospitalizations but more all-cause, noncardiovascular, and bleeding hospitalizations post-TAVR. They found that the reduction in hospitalizations varied by specific patient subgroups and thus advised that payors and providers seeking to reduce resource use may consider strategies designed to improve processes of care among patients with increased resource utilization post-TAVR as compared with pre-TAVR.

The study included 15,324 patients at 328 sites with Medicare linkage undergoing TAVR, with median patient age of 84 years, median Society of Thoracic Surgeons Predicted Risk of Mortality score of 7.0, and 61.1% patients underwent TAVR via transfemoral access.

The investigators reported the following in JACC:

• Post-TAVR heart failure hospitalization rates and hospitalized days were reduced compared with pre-TAVR (rate ratio, 0.87 and 0.95, respectively; P < .01 for all).
• All-cause, noncardiovascular, and bleeding hospitalization rates and hospitalized days were increased post-TAVR (P < .01 for all).
• Post-TAVR hospitalizations were reduced the most among those with left ventricular ejection fraction < 30%.
• Mean post-TAVR costs were reduced among all TAVR patients (rate ratio, 0.95; P < .01) and among 1-year survivors (rate ratio, 0.90; P < .01).