The Evolving Management of Aortic Valve Disease: 5-Year Trends in SAVR, TAVR, and Medical Therapy
Section snippets
Methods
Data were obtained from the Nationwide Readmissions Database (NRD), the largest, all-payer inpatient care database of the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project (HCUP) containing an approximately 20% stratified sample of discharges from all hospitals in 27 US states.12 Data from the NRD and its sister database, the National Inpatient Sample (NIS), have been used for multiple previous studies evaluating patients who have undergone TAVR.13, 14, 15, 16
Results
The sample population included 366,909 patients with IA discharges for aortic valve disease and one of the following procedures or diagnoses: SAVR (n = 64,695), TAVR (n = 18,107), CHF (n = 276,955), UA (n = 11,074), NSTEMI (n = 47,749), or syncope (n = 21,858).
The average age was 77.8 years, and 48.7% of the study population was female. Fifty-eight percent (57.9%) of patients had major or extreme loss of function due to severity of illness, and 53.0% of patients had major or extreme likelihood
Discussion
In a large, nationally-representative sample, the number of patients hospitalized for aortic valve disease increased 48.1% from 2012 through 2016. The likelihood of receiving TAVR increased with a RRR of 4.57 relative to SAVR and 4.41 relative to MT, a novel finding. However, not all patients and hospitals absorbed TAVR equally: increasing age, female sex, severity of illness rating, high number of diagnoses, not-for-profit hospital ownership, large hospital size, and teaching hospital status
Conclusions
From 2012 through 2016, the use of TAVR increased at the expense of both SAVR and MT. The greatest use of TAVR was associated with patients at elevated surgical risk and hospitals that were large, not-for-profit, and urban teaching hospitals. Expected expansion of TAVR indications portends continued growth of TAVR and reduction in SAVR and MT. The inequitable distribution of TAVR therapy must be addressed.
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