Trends in Costs and Risk Factors of 30-Day Readmissions for Transcatheter Aortic Valve Implantation
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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Authors contributed to this work equally.