Outcomes of Transcatheter Aortic Valve Implantation in Nonagenarians and Octogenarians (Analysis from the National Inpatient Sample Database)

https://doi.org/10.1016/j.amjcard.2023.04.049Get rights and content

Risks among nonagenarian (age ≥90 years) and octogenarian (age 80 to 89 years) patients who underwent transcatheter aortic valve implantation (TAVI) compared with clinically similar septuagenarian (age 70 to 79 years) patients remain unclear. This study aimed to assess the outcomes of TAVI in nonagenarians and octogenarians compared with septuagenarians. We conducted a retrospective cohort study using the National Inpatient Sample database to identify patients aged ≥70 years hospitalized for TAVI from 2016 to 2020 and to compare outcomes in nonagenarians and octogenarians versus septuagenarians. The primary outcome was in-hospital mortality. Secondary outcomes included procedural complications, length of stay (LOS), and total costs. The trends in in-hospital outcomes were evaluated. Results were adjusted for demographic/clinical factors. The total cohort included 263,325 patients hospitalized for TAVI, of whom 11.9% were nonagenarians, 51.1% octogenarians, and 37.0% septuagenarians. After adjustment, nonagenarians and octogenarians had higher odds of in-hospital mortality (adjusted odds ratio 1.80, 95% confidence interval 1.34 to 2.41 for nonagenarians; adjusted odds ratio 1.65, 95% confidence interval 1.35 to 2.01 for octogenarians), heart block, permanent pacemaker insertion, stroke, major bleeding, blood transfusion, and palliative care consultation than septuagenarians (all p <0.01). LOS was longer and the total costs were higher for nonagenarians and octogenarians (both p <0.01). Over the study period, in-hospital mortality decreased in nonagenarians (ptrend = 0.04), and major bleeding, permanent pacemaker insertion, LOS, and costs decreased in all patients aged ≥70 years (ptrend <0.01). In conclusion, nonagenarians and octogenarians who underwent TAVI have higher rates of mortality and procedure-related complications than clinically similar septuagenarians. Further research is necessary to optimize outcomes in this frail population.

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.

Image, graphical abstract
  1. Download : Download high-res image (129KB)
  2. Download : Download full-size image

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.

References (39)

  • Y Sammour et al.

    Incidence, predictors, and implications of permanent pacemaker requirement after transcatheter aortic valve replacement

    JACC Cardiovasc Interv

    (2021)
  • R Sweda et al.

    Discharge location and outcomes after transcatheter aortic valve implantation

    Am J Cardiol

    (2021)
  • D Tchetche et al.

    Cerebrovascular events post-transcatheter aortic valve replacement in a large cohort of patients: a FRANCE-2 registry substudy

    JACC Cardiovasc Interv

    (2014)
  • A Chieffo et al.

    Transcatheter aortic valve implantation with the Edwards SAPIEN versus the Medtronic CoreValve Revalving system devices: a multicenter collaborative study: the PRAGMATIC Plus Initiative (Pooled-RotterdAm-Milano-Toulouse In Collaboration)

    J Am Coll Cardiol

    (2013)
  • JD Carroll et al.

    Procedural experience for transcatheter aortic valve replacement and relation to outcomes: the STS/ACC TVT registry

    J Am Coll Cardiol

    (2017)
  • United States Central Bureau. Census Bureau releases comprehensive analysis of fast-growing 90-and-older population....
  • GW Eveborn et al.

    The evolving epidemiology of valvular aortic stenosis. the Tromsø study

    Heart

    (2013)
  • MB Leon et al.

    Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery

    N Engl J Med

    (2010)
  • Agency for Healthcare Research and Quality (AHRQ). Overview of the national (nationwide) inpatient sample. Healthcare...
  • Cited by (0)

    Funding: none.

    View full text