Incidence, Trends, and Predictors of Palliative Care Consultation After Aortic Valve Replacement in the United States

2018 ◽  
Vol 34 (2) ◽  
pp. 111-117 ◽  
Author(s):  
Tomo Ando ◽  
Oluwole Adegbala ◽  
Takeshi Uemura ◽  
Emmanuel Akintoye ◽  
Said Ashraf ◽  
...  
Keyword(s):  
Palliative Care ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
The United States ◽  
Safe Procedure ◽  
Index Hospitalization ◽  
Do Not Resuscitate ◽  
Incidence Trends ◽  
Palliative Care Consultation

Aim: Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) have become a reasonably safe procedure with acceptable morbidity and mortality rate. However, little is known regarding the incidence, trends, and predictors of palliative care (PC) consult in aortic valve replacement (AVR) patients. The main purpose of this analysis was to assess the incidence, trends, and predictors of PC consultation in AVR recipients using the Nationwide Inpatient Sample (NIS) database. Materials and Methods: We queried the NIS database from 2005 to September 2015 to identify those who underwent TAVR or SAVR and had PC referral during the index hospitalization. Adjusted odds ratio (aOR) was calculated to identify patient demographic, social and hospital characteristics, and procedural characteristics associated with PC consult using multivariable regression analysis. We also reported the trends of PC referral in AVR recipients. Results: A total of 522 765 admissions (mean age: 75.3 ± 7.8 years, 40.3% female) who had TAVR (1.7% transapical and 9.2% endovascular approach) and SAVR (89.2%) were identified. Inpatient mortality was 3.96%, and 0.5% patients of the total admissions had PC consultation. The PC referral for SAVR increased from 0.90 to 7.2 per 1000 SAVR from 2005 to 2015 ( P = .011), while it remained stable ranging from 9.30 to 13.3 PC consults per 1000 TAVR ( P = .86). Age 80 to 89 (aOR: 1.93), age ≥90 years (aOR: 2.57), female sex (aOR: 1.36), electrolyte derangement (aOR: 1.90), weight loss (aOR: 1.88), and do not resuscitate status (aOR: 44.4) were associated with PC consult. West region (aOR: 1.46) and Medicaid (aOR: 3.05) were independently associated with PC consult. Endovascular (aOR: 1.88) and transapical TAVR (aOR: 2.80) had higher PC referral rates compared with SAVR. Conclusions: There was an increase in trends for utilization of PC service in SAVR admissions while it remained unchanged in TAVR cohort, but the overall PC referral rate was low in AVR recipients during the index hospitalization.

Abstract 370: Trends, Incidence and In-hospital Outcomes of Frailty Among Patients Hospitalized for Transcatheter Aortic Valve Replacement in The United State

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Olakanmi O Olagoke ◽  
Emmanuel Akuna ◽  
Iriagbonse Asemota ◽  
Karol C Quelal
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
The United States ◽  
Categorical Variables ◽  
Safe Procedure ◽  
Hospital Outcomes ◽  
Transcatheter Aortic Valve ◽  
Frail Patients

Background: Transcatheter aortic valve replacement (TAVR) is a relatively safe procedure and is fast becoming the preferred approach for aortic valve replacement in low risk patients. Although frail patients who pose high surgical risk may benefit from TAVR, little is known about the trends and outcomes of TAVR in frail patients admitted for TAVR. We sought to describe the trend, incidence and in-hospital outcomes of frailty in patients hospitalized for TAVR. Methods: We utilized the National Inpatient Sample database to identify patients admitted for TAVR between January 1, 2010 to December 31, 2014. We identified frail patients using the Johns Hopkins Adjusted Clinical Groups (ACG) frailty-defining diagnoses indicator. We used the appropriate ICD-9-CM codes to identify the diagnoses. Proportions and frequencies were generated for categorical variables and differences were reported using the chi square test. We used student’s t-test to analyze differences in means for continuous variable. Predictors of frailty and mortality were assessed using logistic regression. Results: Of the 42243 TAVR admissions, 3.8% were identified as frail based on the John Hopkins' ACG frailty defining indicators. There is an increasing trend of TAVR use in frail patients from 2.1% in 2011 to 3.8% in 2014 of all the TAVR admissions (P trend =0.000). Predictors of frailty include older age group(aOR 1.65 95% CI 1.12-2.44 for age more than 80years compared to 18-64years), female sex(aOR 1.20 95% CI 1.07-1.35), depression (aOR 1.50 95% CI 1.23-1.82), complicated diabetes(aOR 1.47 95% CI 1.16-1.86) and significant weight loss (aOR 16.37 95% CI 14.41-18.60). Compared to non-frail patients, frail patients had a higher likelihood of in-hospital mortality (8.8% compared to 4.0% p=0.000), longer hospital stay (13.65±11.65 compared to 7.85±6.99 days in non-frail patients). Conclusion: Frailty is associated with poorer outcomes in patients hospitalized for TAVR in the United States. Identification of predisposing factors to frailty and optimization of these factors when possible may help reduce adverse outcomes in this patient population. More studies are needed to clearly elucidate the effect of frailty on TAVR outcomes.

Trends and Predictors of Palliative Care Consultation Among Patients Admitted for LVAD: A Retrospective Analysis From the Nationwide Inpatient Sample Database From 2006-2014

2021 ◽  
pp. 104990912110218
Author(s):  
Karol Quelal ◽  
Olankami Olagoke ◽  
Anoj Shahi ◽  
Andrea Torres ◽  
Olisa Ezegwu ◽  
...  
Keyword(s):  
Palliative Care ◽  
Nationwide Inpatient Sample ◽  
Metastatic Cancer ◽  
The United States ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Incidence Trends ◽  
Palliative Care Consultation ◽  
Care Consultation

Background: Left ventricular assist devices (LVADs) are an essential part of advanced heart failure (HF) management, either as a bridge to transplantation or destination therapy. Patients with advanced HF have a poor prognosis and may benefit from palliative care consultation (PCC). However, there is scarce data regarding the trends and predictors of PCC among patients undergoing LVAD implantation. Aim: This study aims to assess the incidence, trends, and predictors of PCC in LVAD recipients using the United States Nationwide Inpatient Sample (NIS) database from 2006 until 2014. Methods: We conducted a weighted analysis on LVAD recipients during their index hospitalization. We compared those who had PCC with those who did not. We examined the trend in palliative care utilization and calculated adjusted odds ratios (aOR) to identify demographic, social, and hospital characteristics associated with PCC using multivariable logistic regression analysis. Results: We identified 20,675 admissions who had LVAD implantation, and of them 4% had PCC. PCC yearly rate increased from 0.6% to 7.2% (P < 0.001). DNR status (aOR 28.30), female sex (aOR 1.41), metastatic cancer (aOR: 3.53), Midwest location (aOR 1.33), and small-sized hospitals (aOR 2.52) were positive predictors for PCC along with in-hospital complications. Differently, Black (aOR 0.43) and Hispanic patients (aOR 0.25) were less likely to receive PCC. Conclusion: There was an increasing trend for in-hospital PCC referral in LVAD admissions while the overall rate remained low. These findings suggest that integrative models to involve PCC early in advanced HF patients are needed to increase its generalized utilization.

Temporal Trends in Resource Use, Cost, and Outcomes of Transcatheter Aortic Valve Replacement in the United States

2020 ◽  
Vol 95 (12) ◽  
pp. 2665-2673
Author(s):  
Akram Kawsara ◽  
Samian Sulaiman ◽  
Jane Linderbaum ◽  
Sarah R. Coffey ◽  
Fahad Alqahtani ◽  
...  
Keyword(s):  
United States ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Resource Use ◽  
Transcatheter Aortic Valve Replacement ◽  
Temporal Trends ◽  
The United States ◽  
Transcatheter Aortic Valve

scholarly journals Socioeconomic and Geographic Characteristics of Hospitals Establishing Transcatheter Aortic Valve Replacement Programs, 2012–2018

2021 ◽  
Author(s):  
Ashwin S. Nathan ◽  
Lin Yang ◽  
Nancy Yang ◽  
Sameed Ahmed M. Khatana ◽  
Elias J. Dayoub ◽  
...  
Keyword(s):  
United States ◽  
Socioeconomic Status ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Metropolitan Areas ◽  
The United States ◽  
Medicare Beneficiaries ◽  
Transcatheter Aortic Valve

Background: Despite the benefits of novel therapeutics, inequitable diffusion of new technologies may generate disparities. We examined the growth of transcatheter aortic valve replacement (TAVR) in the United States to understand the characteristics of hospitals that developed TAVR programs and the socioeconomic status of patients these hospitals served. Methods: We identified fee-for-service Medicare beneficiaries aged 66 years or older who underwent TAVR between January 1, 2012, and December 31, 2018, and hospitals that developed TAVR programs (defined as performing ≥10 TAVRs over the study period). We used linear regression models to compare socioeconomic characteristics of patients treated at hospitals that did and did not establish TAVR programs and described the association between core-based statistical area level markers of socioeconomic status and TAVR rates. Results: Between 2012 and 2018, 583 hospitals developed new TAVR programs, including 572 (98.1%) in metropolitan areas, and 293 (50.3%) in metropolitan areas with preexisting TAVR programs. Compared with hospitals that did not start TAVR programs, hospitals that did start TAVR programs treated fewer patients with dual eligibility for Medicaid (difference of −2.83% [95% CI, −3.78% to −1.89%], P ≤0.01), higher median household incomes (difference $2447 [95% CI, $1348–$3547], P =0.03), and from areas with lower distressed communities index scores (difference −4.02 units [95% CI, −5.43 to −2.61], P ≤0.01). After adjusting for the age, clinical comorbidities, race and ethnicity and socioeconomic status, areas with TAVR programs had higher rates of TAVR and TAVR rates per 100 000 Medicare beneficiaries were higher in core-based statistical areas with fewer dual eligible patients, higher median income, and lower distressed communities index scores. Conclusions: During the initial growth phase of TAVR programs in the United States, hospitals serving wealthier patients were more likely to start programs. This pattern of growth has led to inequities in the dispersion of TAVR, with lower rates in poorer communities.

Economic Considerations in Access to Transcatheter Aortic Valve Replacement

2022 ◽  
Author(s):  
Kriyana P. Reddy ◽  
Peter W. Groeneveld ◽  
Jay Giri ◽  
Alexander C. Fanaroff ◽  
Ashwin S. Nathan
Keyword(s):  
United States ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
The United States ◽  
Socioeconomically Disadvantaged ◽  
Transcatheter Aortic Valve ◽  
Economic Considerations

Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis, with the number of procedures and sites offering the procedure steadily rising over the past decade in the United States. Despite this, growth into certain markets has been limited as hospitals have to balance high TAVR costs with the ability to offer a complete array of state-of-the-art therapies for aortic stenosis. This trade-off often results in decreased access to TAVR services by patients cared for in hospitals that cannot afford these services or have difficulty meeting procedural requirements, recruiting skilled physicians, and initiating and then maintaining a functioning TAVR program. The lack of access is more common among patients of color or those who are socioeconomically disadvantaged. The purpose of this review is to describe the hospital-level economic considerations of TAVR in the United States and the resulting effects on geographic, racial, ethnic, and socioeconomic access for Americans.

Ministernotomy for Aortic Valve Replacement Versus Conventional Sternotomy, a Choice for a Better outcome

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Refaat Mohamed Refaat ◽  
Gamal Samy ◽  
Faisal Morad ◽  
Nabil Abd Gawad
Keyword(s):  
Aortic Valve ◽  
Blood Loss ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Statistical Difference ◽  
Statistical Significance ◽  
P Value ◽  
Safe Procedure ◽  
Transfusion Requirements ◽  
Renal Complication

Abstract Background ​ In the era of minimal invasive cardiac surgery, Ministernotomy Aortic valve .replacement have been proposed as an alternative to conventional full sternotomy approach Aim of the Work ​: ​​To evaluate the safety and efficacy of AVR through ministernotomy in comparison to full sternotomy AVR in terms of Cardiac cause mortality, Neurological and .Renal complication​s Patients and Methods ​After gaining the institutional ethical committee approval, the study included all patients who underwent isolated, DE novo, open aortic valve replacement during the period from June 2017 till June 2019 performed by multiple surgeons at cardiothoracic .academy Ain Shams University Results ​ The study included 60 patients; 32 patients performed through full sternotomy (53.3%) and 28 patients through ministernotomy (46.6%).​ ​Post-operative arrhythmias occurred in full sternotomy in 6 cases (18.8%) where in mini-sternotomy, only 3 cases (12%) developed arrhythmias with no significant statistical difference (p value = ​0.558)​. Cerebrovascular stroke was recorded 1 patient (3%) versus 4 cases (14.3%) in the full sternotomy versus the ministernotomy groups respectively with no Statistical difference between the 2 groups (p value = 0.119).​ Postoperative acute renal impairment was recorded​ in 3 cases (9.4%) vs 2 patients (7.1%) in the full sternotomy vs the ministernotomy groups respectively (p value = 0.755). There was no​ mortality in either groups. Mean post-operative Ventilation hours were 17.21hrs with SD ± 11.026 versus 14.97hrs with SD ​± ​6.473 (p value is 0.35) for the full sternotomy versus the ministernotomy groups respectively. Mean blood loss was 305.51ml with SD ± 282.662 versus 230.36ml with SD ​± ​247.708 (p value is 0.277) for the full versus the ministernotomy groups respectively. Mean units of blood transfused was 2.31Units with SD ​± ​0.926 versus 1.14Units with SD ​±​ 0.591 in the full sternotomy versus the ministernotomy groups with high statistical significance between both groups (p value less than 0.01). Mean ICU stay was 2.66 days with SD ​±​ 0.915 and was 3.1days with SD ​±​ 2.743 (p .value is 0.424) for the full sternotomy versus the ministernotomy groups respectively Conclusion ​ Ministernotomy Aortic valve replacement was found to be a safe procedure​ compared to full sternotomy approach. Patients who had their surgery through the mini approach had less amount of blood loss, blood transfusion requirements, ventilation time which all led to less duration of ICU and hospital stay, resulting in a better outcome for the .patients

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