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Transcatheter aortic valve implantation with and without mitral stenosis - A National Readmission Database study
Shafaqat Ali1, Harshith Thyagaturu2, Lalitsiri Atti3
1Department of Internal Medicine, Louisiana State University, Shreveport, LA, USA.
Introduction:
Mitral valve stenosis (MS) can be concomitantly present in patients undergoing Transcatheter Aortic Valve Implantation (TAVI). Some studies have reported up to one-fifth of patients who underwent TAVI also have MS. The relationship between mitral stenosis and TAVI has led to concerns regarding increased adverse cardiac outcomes during and after the procedure.
Methods:
The Nationwide Readmission Database (NRD 2016-2019) was utilized to identify TAVI patients with MS with ICD-10-CM codes. The primary outcome was a 30-day readmission rate. Secondary outcomes included predictors of all-cause readmissions, length of stay, and total hospitalization cost. We assessed readmission frequency with a national sample weighed at 30 days following the index TAVI procedure. Unadjusted and adjusted odds ratios were analyzed for in-hospital outcomes using univariate and multivariate logistic regression for study cohorts.
Results:
A total of 217,147 patients underwent TAVI procedures during the queried time period of the study. Of these patients, 2140 (0.98 %) had MS. The overall 30-day all-cause readmission rate for the study cohort was 12.4 %. TAVI patients with MS had higher rates of 30-day readmissions (15.8 % vs 12.3 %, aOR 1.22, CI: 1.03-1.45, P < 0.01). Additionally, TAVI patients with MS had longer lengths of hospital stay during index admissions (5.7 vs. 4.3 days), along with higher total hospitalization costs ($55,157 vs. $50,239). In contrast, in-hospital mortality during index TAVI admission did not differ significantly between the two groups, although there was a trend toward higher mortality in the MS group (2.1 % vs. 1.5 %). Among the TAVI MS cohort, patients admitted on weekends (aOR: 1.11, 95 % CI: 1.02-1.22, P = 0.01), admitted to non-metropolitan hospitals (aOR: 1.29, 95 % CI: 1.11-1.66, P = 0.04) and presence of co-morbidities such as atrial fibrillation (AF)/flutter (aOR: 1.24, 95 % CI: 1.16-1.32, P < 0.01), chronic obstructive pulmonary disease (COPD) (aOR: 1.16, 95 % CI: 1.11-1.22, P < 0.01), prior stroke (aOR: 1.09, 95 % CI: 1.03-1.14, P < 0.01), chronic kidney disease (CKD) ≥3 (aOR: 1.16, 95 % CI: 1.11-1.22, P < 0.01), end-stage renal disease (ESRD) (aOR: 1.75, 95 % CI: 1.61-1.90, P < 0.01), and anemia (aOR: 1.23, 95 % CI: 1.18-1.28, P < 0.01) were associated with increased odds of readmission.
Conclusion:
Concomitant MS in patients undergoing TAVI is associated with higher readmission rates and total hospital costs. This can contribute significantly to healthcare-related burdens. Further studies are required to evaluate in-hospital outcomes and predictors of readmission in patients undergoing TAVI with the presence of concomitant MS.
Insights
Patients undergoing Transcatheter Aortic Valve Implantation (TAVI) with concomitant Mitral Stenosis (MS) face higher 30-day readmission rates and increased hospitalization costs. These findings highlight the significant healthcare burden associated with TAVI patients who also have MS.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Health Services Research
Background:
- Mitral stenosis (MS) frequently coexists with conditions requiring Transcatheter Aortic Valve Implantation (TAVI).
- Up to 20% of TAVI patients may have concurrent MS, raising concerns about procedural risks and outcomes.
- The interplay between MS and TAVI necessitates a closer examination of associated adverse cardiac events.
Purpose of the Study:
- To investigate the impact of concomitant Mitral Stenosis (MS) on 30-day readmission rates and hospitalization costs in patients undergoing Transcatheter Aortic Valve Implantation (TAVI).
- To identify predictors of all-cause readmissions among TAVI patients with MS.
Main Methods:
- Utilized the Nationwide Readmission Database (NRD) from 2016-2019 to identify TAVI patients with MS using ICD-10-CM codes.
- Analyzed 30-day all-cause readmission rates as the primary outcome, alongside length of stay and total hospitalization costs.
- Employed univariate and multivariate logistic regression to assess in-hospital outcomes and identify readmission predictors.
Main Results:
- Out of 217,147 TAVI patients, 2140 (0.98%) had MS. TAVI patients with MS exhibited higher 30-day readmission rates (15.8% vs. 12.3%) and longer hospital stays (5.7 vs. 4.3 days).
- Hospitalization costs were significantly higher for TAVI patients with MS ($55,157 vs. $50,239).
- In-hospital mortality did not significantly differ, but weekend admissions, non-metropolitan hospital admissions, and comorbidities like AFib/flutter, COPD, prior stroke, CKD, ESRD, and anemia were associated with increased readmission odds.
Conclusions:
- Concomitant MS in TAVI patients is linked to elevated readmission rates and increased total hospitalization costs, contributing to healthcare burdens.
- Further research is warranted to explore in-hospital outcomes and specific readmission predictors in this patient cohort.
- The findings underscore the need for targeted management strategies for TAVI patients with co-existing MS.
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