Association between institutional volume of transcatheter mitral valve repair and readmission rates: A report from the Nationwide Readmission Database

https://doi.org/10.1016/j.ijcard.2023.04.034Get rights and content

Highlights

  • There was a substantial institutional variation in volume of transcatheter edge-to-edge repair.

  • Higher institutional volume was associated with a decreased risk of 180-day readmission rate.

  • This association was mostly observed in non-elective cases.

  • Our study suggests the importance of highly skilled heart teams of transcatheter edge-to-edge repair.

Abstract

Background

Transcatheter edge-to-edge repair (TEER) of the mitral valve has become an established therapy for certain patients with mitral regurgitation. However, little is known about the association between institutional volume variations and long-term outcomes using a large-scale database. Our study aimed to describe the institutional variations of TEER and also investigate its association with 180-day readmission rates.

Methods

We conducted a retrospective cohort study of TEER performed in the US from the 2019 Nationwide Readmission Database. We divided the patients according to the tertiles based on volume of TEER (Q1 [lowest]-Q3 [highest]) and evaluated the association with 180-day readmission rates.

Results

A total of 4922 patients (mean age 76.8 ± 10.4 years, and 54.5% male) who underwent TEER at 250 institutions were included in the analyses. There was substantial variation in the number of TEER performed annually across institutions (median 25.0 [11.6–52.5] cases). Readmission within 6-months following TEER was 37.0%, mainly due to heart failure. Higher institutional volume was associated with a reduced incidence of 180-day readmissions (HR of Q3 0.68 95%CI 0.50–0.93, vs Q1; p = 0.016). This association was more prominent in non-elective cases (HR of Q3 0.50 95%CI 0.31–0.81, vs Q1; p = 0.005).

Conclusions

Using a nationally representative contemporary database, our study found substantial institutional variation in volume of TEER cases. Higher institutional volume was associated with a decreased risk of 180-day readmission rate, particularly in non-elective cases. Our study suggests the importance of highly skilled heart teams when treating patients who need urgent transcatheter intervention for mitral regurgitation.

Introduction

Transcatheter edge-to-edge repair (TEER) of the mitral valve has become an established therapy for certain patients with at least moderate-to-severe mitral regurgitation. [[1], [2], [3]] Since its approval, >80,000 patients have undergone TEER at >250 centers in the United States (US). [4] Given that TEER requires relatively complex techniques and close multidisciplinary collaboration teams (i.e. operators, echocardiographers and anesthesiologists), monitoring the risk-adjusted outcomes using national databases are essential to improve the quality of care for patients undergoing TEER. Although previous studies have evaluated the association of institutional experience with clinical outcomes, these have mainly focused on short-term outcomes. [5,6] Little is known about the association between the institutional volume and long-term outcomes using large databases. Our study aimed to describe the institutional volumes of TEER and investigate their association with 180-day readmission rates using a nationally representative contemporary US database. We hypothesized that the institutional learning curve could influence long-term outcomes after TEER, as these patients remain at substantial risk for periprocedural complications and require close monitoring even after discharge.

Section snippets

Data source

For this retrospective cohort study, the Nationwide Readmission Database (NRD), a database of inpatient information designed for readmission analyses developed by the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project (HCUP), was used. The NRD contains approximately 18 million discharge data each year in the US from 28 geographically dispersed states, including patients' age, sex, comorbidities, hospital bed size, length of hospital stay, inpatient procedures

Baseline characteristics and institutional variations of TEER

Table 1 presents the baseline characteristics of the study cohort stratified by tertiles of hospital TEER volume. A total of 4922 patients who underwent TEER (mean age 76.8 ± 10.4 years, and 54.5% male) at 250 institutions were included in the analyses. No significant differences were identified among the three groups. Patients in the highest tertile of the procedure (Q3) were found to have a higher prevalence of hypertension, HF, and anemia. We observed significant variations in the number of

Discussion

TEER of the mitral valve has become an established therapy for certain patients with at least moderate-to-severe MR, however, little is known about the association between the institutional TEER volumes and long-term outcomes using a large-scale database. In this study, we aimed to describe the institutional variations of TEER volume and investigate its association with 180-day readmission rates using a nationally representative contemporary database in the US. The main findings are as follows:

Conclusions

Using a nationally representative contemporary database in the US, we demonstrated that there was a substantial institutional variation in volume of TEER cases and that higher institutional volume was associated with a decreased risk of 180-day readmission rate. Notably, this association was mostly observed in non-elective cases, suggesting the importance of highly skilled heart teams when treating patients who need urgent transcatheter intervention for MR. Further research is required to

Funding

None.

Declaration of Competing Interest

Dr. Inohara is an employee of Eli Lilly Japan K.K., but was not affiliated with Eli Lilly Japan K.K. at the time of the initial submission. Dr. Kohsaka received investigator-initiated grant funding from Pfizer and AstraZeneca; and lecture fees from Pfizer and Bristol-Myers Squibb. Dr. Latib is a consultant for Edwards Lifesciences, Medtronic, Abbott, Boston Scientific.

Cited by (1)

1

Contributed equally as first authors.

View full text