Abstract
Background
Rehospitalization rates post-transcatheter aortic valve replacement (TAVR) are high;
however, it is not known how these compare with pre-TAVR hospitalization rates. Our
objective was to determine the association between the index TAVR and hospitalization
rates pre- and postprocedure.
Methods
A retrospective observational study was performed including all TAVR procedures performed
in Ontario, Canada, between 2013 and 2017. Patients who died during the index hospitalization
were excluded. The primary outcome was all-cause hospitalization within 1 year of
TAVR discharge. Hospitalization rates per person-year were calculated and compared
for each of the following analogous time periods pre- and post-index TAVR: 1 to 30,
31 to 90, 91 to 365, and 1 to 365 days. Poisson regression models were used to generate
rate ratios to compare hospitalization rates.
Results
The final study cohort included 2547 patients. In the year before TAVR, 60.2% of patients
were hospitalized, compared with 45.9% in the year following the procedure. The rate
ratio (RR) for the year post-TAVR compared with pre-TAVR was 0.82 (95% confidence
interval [CI], 0.77- 0.88). When comparing each parallel time period post- vs pre-TAVR,
all intervals were associated with significant reductions in hospitalization after
TAVR, except the 30-day periprocedural period. The largest change in hospitalization
rates occurred in the 31 to 90 days post- vs the corresponding period pre-TAVR (RR:
0.57; 95% CI, 0.50-0.64)
Conclusion
TAVR is associated with a significant and sustained reduction in all-cause hospitalization
in the year following the procedure compared with the preprocedural period.
Résumé
Contexte
Les taux de réhospitalisation après un remplacement valvulaire aortique par cathéter
(RVAC) sont élevés; on ne sait toutefois pas comment ces taux se comparent aux taux
d’hospitalisation avant le RVAC. Notre objectif était de déterminer l’association
entre un RVAC de référence et les taux d’hospitalisation avant et après l’intervention.
Méthodologie
Nous avons réalisé une étude observationnelle rétrospective portant sur tous les RVAC
exécutés en Ontario (Canada) entre 2013 et 2017. Les patients qui sont décédés durant
l’hospitalisation de référence ont été exclus. Le principal paramètre d’évaluation
était l’hospitalisation toutes causes confondues dans l’année suivant la sortie de
l’hôpital après un RVAC. Les taux d’hospitalisation par patient-année ont été calculés
et comparés pour chacune des périodes analogues suivantes avant et après le RVAC de
référence : du 1er au 30e jour, du 31e au 90e jour, du 91e au 365e jour et du 1er au 365e jour. Des modèles de régression de Poisson ont été utilisés pour produire les rapports
des taux (RT) qui ont servi à comparer les taux d’hospitalisation.
Résultats
La cohorte définitive de l’étude comptait 2 547 patients. Dans l’année précédant le
RVAC, 60,2 % des patients ont été hospitalisés, comparativement à 45,9 % des patients
dans l’année suivant l’intervention. Le rapport du taux d’hospitalisation dans l’année
suivant le RVAC au taux dans l’année précédant le RVAC était de 0,82 (intervalle de
confiance [IC] à 95 %, 0,77-0,88). La comparaison de chacune des périodes parallèles
avant et après le RVAC a révélé des réductions significatives des hospitalisations
après le RVAC pour tous les intervalles, sauf pour ce qui est des deux périodes de
30 jours précédant et suivant immédiatement le RVAC. La variation la plus importante
des taux d’hospitalisation a été observée durant la période du 31e au 90e jour suivant le RVAC par rapport à la période correspondante précédant le RVAC (RT
: 0,57; IC à 95 %, 0,50-0,64).
Conclusion
Le RVAC est associé à une réduction significative et durable des hospitalisations
toutes causes confondues dans l’année qui suit l’intervention, comparativement à l’année
qui la précède.
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Article info
Publication history
Published online: January 20, 2020
Accepted:
January 8,
2020
Received:
July 26,
2019
Footnotes
See editorial by Simon and Asgar, pages 1572—1573 of this issue.
See page 1622 for disclosure information.
Identification
Copyright
© 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Interpreting Administrative Data About Transcatheter Aortic Valve Replacement Effects on Hospitalisation Outcomes: The Devil’s in the DetailsCanadian Journal of CardiologyVol. 36Issue 10
- PreviewTranscatheter aortic valve replacement (TAVR) is the standard of care for prohibitive- or high-risk patients with symptomatic aortic stenosis (AS).1 This paradigm shift in the treatment of AS has raised concerns about health care resource utilisation owing to the procedural costs and subsequent hospitalisations in this patient population. Rates of rehospitalisation at 30 days and 1 year are high, 15% and 45% respectively, leading to increased health care expenditure.23 An analysis by Vemulapalli et al.
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