トランスキャテーターによる大動脈弁置換の時間的な傾向と臨床的結果:集団ベースの研究
Gabby Elbaz-Greener1, Shannon Masih2, Jiming Fang2
1Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (G.E-G., D.T.K., H.C.W.).
Circulation
|March 8, 2018
まとめ
トランスキャテーター大動脈弁置換 (TAVR) の待ち時間は,補償後安定したが,長いままである. これらの遅延は,患者の死亡率と罹患率と関連しており,TAVRの容量とアクセスを増やす必要性を強調しています.
科学分野:
- 心臓病科
- 介入心臓科
- 医療サービス研究
背景:
- トランスキャテーター大動脈弁置換 (TAVR) は重度の大動脈狭窄症の重要な治療法です.
- TAVRの需要の増加は,医療の能力を上回り,待機時間が長くなり,患者のアクセスが減少する可能性があります.
- TAVRの待ち時間傾向とその臨床的影響を評価することは,患者のケアを最適化するために極めて重要です.
研究 の 目的:
- TAVRの待ち時間におけるタイムトレンドを分析する
- TAVR 待ち時間に関連する死亡率と入院率を含む臨床的影響を評価する.
- 省による補償がTAVRの待ち時間や結果に影響を及ぼしたかどうかを判断する.
主な方法:
- カナダのオンタリオで実施された集団ベースの研究では,2010年4月から2016年3月までのTAVRの紹介を特定した.
- TAVR手順への紹介から平均の総待機時間は,主要なアウトカムでした.
- 断片回帰では,2012年9月の払い戻しの前後の傾向を分析し,臨床結果には,待機リストでの死亡率と心不全の入院が含まれていました.
主要な成果:
- 研究には4461人の紹介者が含まれており,その50%がTAVRを受けた.
- 返済後の平均待ち時間は 80 日で安定し,変化はありません.
- 待機リストでの死亡率は約2%で,心臓不全の入院率は80日後に12%で,事件は待機時間が長くなるにつれて増加しました.
結論:
- TAVRの待機時間は,払い戻しから約80日で安定しており,生産能力が需要に匹敵していることを示しています.
- 安定した待機期間にもかかわらず,ほぼ3ヶ月の遅延は著しい罹病率と死亡率と関連しています.
- TAVRの容量を増やし,処置を待っている患者の不良臨床結果を軽減するために,アクセスの改善が必要である.
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