Elsevier

The American Journal of Cardiology

Volume 137, 15 December 2020, Pages 89-96
The American Journal of Cardiology

Trends in Costs and Risk Factors of 30-Day Readmissions for Transcatheter Aortic Valve Implantation

https://doi.org/10.1016/j.amjcard.2020.09.041Get rights and content

Highlights

  • Costs of index hospitalizations for TAVI in the U.S. have significantly declined from 2012 to 2017.

  • Costs associated with readmissions have declined from 2012 to 2017.

  • Heart failure, infection, and arrhythmia were the top 3 causes of readmission after TAVI in 2017.

  • Readmissions due to arrhythmia and their costs increased from 2012 to 2017.

As transcatheter aortic valve implantation (TAVI) continues its rapid growth as a treatment approach for aortic stenosis, costs associated with TAVI, and its burden to healthcare systems will assume greater importance. Patients undergoing TAVI between January 2012 and November 2017 in the Nationwide Readmission Database were identified. Trends in cause-specific readmissions were assessed using Poisson regression. Thirty-day TAVI cost burden (cost of index TAVI hospitalization plus total 30-day readmissions cost) was adjusted to 2017 U.S. dollars and trended over year from 2012 to 2017. Overall, 47,255 TAVI were included and 30-day readmissions declined from 20% to 12% (p <0.0001). Most common causes of readmission (heart failure, infection/sepsis, gastrointestinal causes, and respiratory) declined as well, except arrhythmia/heart block which increased (1.0% to 1.4%, p <0.0001). Cost of TAVI hospitalization ($52,024 to $44,110, p <0.0001) and 30-day cost burden ($54,122 to $45,252, p <0.0001) declined. Whereas costs of an average readmission did not change ($9,734 to $10,068, p = 0.06), cost burden of readmissions (per every TAVI performed) declined ($4,061 to $1,883, p <0.0001), including reductions in each of the top 5 causes except arrhythmia/heart block ($171 to $263, p = 0.04). Index TAVI hospitalizations complicated by acute kidney injury, length of stay ≥5 days, low hospital procedural volume, and skilled nursing facility discharge were associated with increased odds of 30-day readmissions. In conclusion, the costs of index hospitalizations and 30-day cost burden for TAVI in the U.S. significantly declined from 2012 to 2017. However, readmissions due to arrhythmia/heart block and their associated costs increased. Continued strategies to prevent readmissions, especially those for conduction disturbances, are crucial in the efforts to optimize outcomes and costs with the ongoing expansion of TAVI.

Section snippets

Methods

Hospitalizations for elective TAVI were identified using the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmission Database (NRD). In 2017, the NRD included over 18 million discharges from 22 states and accounts for 60.0% of the total U.S. resident population and 58.2% of all U.S. hospitalizations.5 It is an all-payer health care database in the United States that is nationally representative and contains verified patient linkage numbers which allows patients to be tracked

Results

Overall, 47,255 patients undergoing TAVI were included and 14% of patients (n = 6,471) were readmitted within 30-days. Of all the readmissions, 33% (n = 2,211) were classified as CV. Between 2012 and 2017, the demographics of patients undergoing TAVI remained relatively stable, Table 1. However, patients undergoing TAVI seemed to have less co-morbidities over time, including significant decreases in prevalence of diabetes mellitus (p <0.0001), hypertension (p <0.0001), chronic obstructive

Discussion

In this analysis of TAVI in the U.S. from 2012 to 2017, one in seven TAVI patients were readmitted within 30-days, with heart failure, infection/sepsis, and arrhythmia/heart block the 3 most common causes. Index TAVI hospitalization costs as well as overall 30-day cost burden have declined during this period, whereas the cost of each readmission has remained largely stable. Although both the overall and cause-specific incidences and costs of readmissions have declined, readmissions for

Conclusions

In conclusion, the costs of index hospitalizations for TAVI in the U.S. significantly declined from 2012 to 2017. In addition, the costs associated with readmissions for TAVI declined during that time due to a reduction in the proportion of TAVI patients needing readmission, whereas the costs of the readmissions themselves have remained largely stable. Readmissions due to arrhythmia or heart block and the costs associated with these readmissions increased over the same period.

Author Statement

Sameer Arora, MD*: Conceptualization; methodology; writing – original draft; review and editing; supervision.

Michael J Hendrickson, BS*: Methodology; Writing – original draft, review and editing; software; formal analysis; data curation; visualization.

Paula D Strassle, PhD, MSPH: Writing – review and editing; methodology; software; formal analysis; data curation.

Arman Qamar, MD, MPH: Writing – review and editing.

Ambarish Pandey, MD: Methodology; Writing – review and editing.

Dhaval Kolte, MD,

Conflict of Interest

Dr. Deepak L. Bhatt discloses the following relationships - Advisory Board: Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care, TobeSoft; Chair: American Heart Association Quality Oversight Committee; Data Monitoring Committees: Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now

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