Elsevier

The American Journal of Cardiology

Volume 163, 15 January 2022, Pages 50-57
The American Journal of Cardiology

Impact of Atrial Fibrillation on Outcomes of Aortic Valve Implantation

https://doi.org/10.1016/j.amjcard.2021.09.036Get rights and content

Graphical Abstract

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New or preexisting atrial fibrillation (AF) is frequent in patients undergoing aortic valve replacement. We evaluated whether the presence of AF during transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) impacts the length of stay, healthcare adjusted costs, and inpatient mortality. The median length of stay in the patients with AF increased by 33.3% as compared with those without AF undergoing TAVI and SAVR (5 [3 to 8] days vs 3 [2 to 6] days, p <0.0001 and 8 [6 to 12] days vs 6 [5 to 10] days, p <0.0001, respectively). AF increased the median value of adjusted healthcare associated costs of both TAVI ($46,754 [36,613 to 59,442] vs $49,960 [38,932 to 64,201], p <0.0001) and SAVR ($40,948 [31,762 to 55,854] vs $45,683 [35,154 to 63,026], p <0.0001). The presence of AF did not independently increase the in-hospital mortality. In conclusion, in patients undergoing SAVR or TAVI, AF significantly increased the length of stay and adjusted healthcare adjusted costs but did not independently increase the in-hospital mortality.

Section snippets

Methods

The study was conducted using the National Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP) data set between 2011 and 2017.14 The population selected from the NIS data set for this study were patients with AS, with and without AF, undergoing TAVI or SAVR between 2011 and 2017. These data include male and female patients >18 years of age. These timeframes were chosen to allow a sufficient run-in period for adoption of TAVI throughout the United States, as well as the

Results

A total of 742,168 patients had AS of which 645,909 patients met the exclusion criteria (Figure 1). Overall, the median (IQR) age of patients was 74 (66 to 81) years, and 62.1% (59,730 patients) were male. The most prevalent comorbidity was hypertension (65.5%; Table 1). In-hospital mortality for the complete cohort was 2.5%. The median (IQR) value of LOS and adjusted healthcare associated costs (HCAC) in the analyzed cohort were 6 (4 to 10) days and $44,299 ($34,006-59,585), respectively.

SAVR

Discussion

This study is a real-world analysis of the LOS, Healthcare associated costs, and in-hospital mortality in patients undergoing interventional procedures for significant AS. The key findings are as follows: (1) the co-existence or development of AF leads to a significantly higher inpatient LOS and Healthcare associated costs in patients undergoing both SAVR and TAVI; (2) when adjusted for all other variables, AF was not associated with increased in-hospital mortality; (3) patients undergoing SAVR

Disclosures

The authors have no conflicts of interest to declare.

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  • Cited by (0)

    Raheel Ahmed and Hiroyuki Sawatari contributed equally to this manuscript.

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    Anwar C. Chahal and Deepak Padmanabhan contributed equally to this manuscript.

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