TAVR Hospital Burdens Reduced in Heart Failure Patients

Hardikkumar Patel, MD

An assessment into transcatheter aortic valve replacement (TAVR) therapy’s effect on hospitalized patient costs, length of stay, and mortality show the first positive results for such endpoints in patient with heart failure (HF).

In a new trial conducted by investigators from Mount Sinai St. Luke’s and West, patients with chronic HF to undergo TAVR in 2016 were found to have significantly improved hospitalization metrics compared to non-HF patients who underwent TAVR.

The findings, presented at the Heart Failure Society of America (HFSA) 2019 Scientific Sessions in Philadelphia, PA, give credence to the benefit of TAVR in intermediate-risk patients not eligible for open heart surgery.

Led by Hardikkumar Patel, MD, of the Department of Internal Medicine, the team assessed data from the 2016 National Inpatient Sample (NIS) to find all patients that underwent TAVR that year. They compared TAVR patients as those with and without HF, based on ICD-10-CM diagnosis codes for systolic and diastolic HF.

Patel and colleagues used multivariate regression to calculate weighted nationwide estimates for hospital mortality, length of stay, and total hospital cost charge. Adjustments were made for patient demographic, socioeconomic, and hospital factors—including bed size, location, teaching status, and the day and month of admission.

They identified 40,005 patients that underwent TAVR in 2016—12,080 (30.2%) with HF, 27,925 (69.8%) without HF. Mean overall HF patient age was 80.4 years, with 44.7% being female. Non-HF patients reported similar demographics (mean age 80.2 years; 46.2% female).

Patients with HF to undergo TAVR reported significantly decreased length of hospital stay (coefficient -1.97; P = .000) and total hospital cost (coefficient -20685.16; P = .000) compared to patients without HF. Their mortality rate was also significantly reduced—more than halved (OR, 0.453; P = .001).

As TAVR has become a more popularized method of valve replacement, its use has become more frequent among older patients—a population more susceptible to comorbid conditions including HF. Patel and colleagues noted this is the first trial showing benefits of the procedure for hospital burden among HF-comorbid patients when compared to patients without HF. More research should follow.

“Further studies are required to elucidate the etiology of this difference,” they concluded.

The study, “In-Hospital Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement in Relation to the Presence of Heart Failure in the United States: An Analysis of the National Inpatient Sample,” was presented at HFSA 2019.