Outcomes of Transcatheter Aortic Valve Implantation in Nonagenarians and Octogenarians (Analysis from the National Inpatient Sample Database)
Graphical abstract
Summary of in-hospital outcomes of TAVI in nonagenarians (aged ≥90 years) and octogenarians (aged 80 to 89 years) compared with septuagenarians (aged 70 to 79 years) after adjustment for baseline characteristics. TAVI = transcatheter aortic valve implantation, NIS = National Inpatient Sample, PPM = permanent pacemaker.
Section snippets
Methods
Hospitalization data were abstracted from the National Inpatient Sample (NIS) database, which is part of the Healthcare Cost and Utilization Project (HCUP) family of databases sponsored by the Agency for Healthcare Research and Quality.7 The NIS is the largest publicly available, fully deidentified, all-payer inpatient health care database in the United States. The NIS is derived from administrative claims submitted by hospitals to statewide organizations across the United States and has
Results
From 2016 through 2020, an estimated 263,325 hospitalizations in the United States met the inclusion criteria, of which an estimated 11.9% were nonagenarians, 51.1% were octogenarians, and 37.0% were septuagenarians (Figure 1). Patients in the nonagenarian and octogenarian groups were more likely to be women and White than septuagenarians (both p <0.01). Nonagenarians and octogenarians, overall, had a lower burden of co-morbidities with lower Elixhauser and Charlson co-morbidity index scores
Discussion
This large national database study demonstrates 3 principal findings: (1) compared with septuagenarians, nonagenarians and octogenarians who underwent TAVI had higher adjusted odds of in-hospital mortality; (2) similarly, complications were more frequent in nonagenarians and octogenarians who underwent TAVI, including heart block requiring PPM insertion, stroke, major bleeding requiring blood transfusion, and palliative care consultation, resulting in longer hospital LOS and higher costs; (3)
Declaration of Competing Interest
Dr. Goldsweig reports consulting fees from Inari Medical and speaking fees from Philips and Edwards Lifesciences. The remaining authors have no conflicts of interest to declare.
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