Philip S Hall1, Colin I O'Donnell2, Verghese Mathew3, Santiago Garcia4, Anthony A Bavry5, Subhash Banerjee6, Hani Jneid7, Ali E Denktas7, John C Giacomini8, Paul M Grossman9, Kul Aggarwal10, Jeffrey M Zimmet11, Elaine E Tseng11, Leo Gozdecki3, Lucas Burke3, Stefan C Bertog12, Maurice Buchbinder8, Mary E Plomondon2, Stephen W Waldo2, Kendrick A Shunk13. 1. University of North Carolina Rex Healthcare, Raleigh, North Carolina. 2. University of Colorado and Rocky Mountain Regional VA Medical Center, Aurora, Colorado. 3. Loyola University Stritch College of Medicine, Maywod, Illinois. 4. University of Minnesota and VA Medical Center, Minneapolis, Minnesota; Valve Science Center, Minneapolis Heart Institute, Minneapolis, Minnesota. 5. University of Florida and VA Medical Center, Gainesville, Florida. 6. University of Texas, Southwestern and North Texas VA Medical Center, Dallas, Texas. 7. Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, Texas. 8. Stanford University and VA Medical Center, Palo Alto, California. 9. University of Michigan and VA Medical Center, Ann Arbor, Michigan. 10. University of Missouri and Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri. 11. University of California and Veterans Affairs Medical Center, San Francisco, California. 12. Valve Science Center, Minneapolis Heart Institute, Minneapolis, Minnesota. 13. University of California and Veterans Affairs Medical Center, San Francisco, California. Electronic address: kendrick.shunk@va.gov.
Abstract
OBJECTIVES: This study sought to describe clinical and procedural characteristics of veterans undergoing transcatheter aortic valve replacement (TAVR) within U.S. Department of Veterans Affairs (VA) centers and to examine their association with short- and long-term mortality, length of stay (LOS), and rehospitalization within 30 days. BACKGROUND: Veterans with severe aortic stenosis frequently undergo TAVR at VA medical centers. METHODS: Consecutive veterans undergoing TAVR between 2012 and 2017 were included. Patient and procedural characteristics were obtained from the VA Clinical Assessment, Reporting, and Tracking system. The primary outcomes were 30-day and 1-year survival, LOS >6 days, and rehospitalization within 30 days. Logistic regression and Cox proportional hazards analyses were performed to evaluate the associations between pre-procedural characteristics and LOS and rehospitalization. RESULTS: Nine hundred fifty-nine veterans underwent TAVR at 8 VA centers during the study period, 860 (90%) by transfemoral access, 50 (5%) transapical, 36 (3.8%) transaxillary, and 3 (0.3%) transaortic. Men predominated (939 of 959 [98%]), with an average age of 78.1 years. There were 28 deaths within 30 days (2.9%) and 134 at 1 year (14.0%). Median LOS was 5 days, and 141 veterans were rehospitalized within 30 days (14.7%). Nonfemoral access (odds ratio: 1.74; 95% confidence interval [CI]: 1.10 to 2.74), heart failure (odds ratio: 2.51; 95% CI: 1.83 to 3.44), and atrial fibrillation (odds ratio: 1.40; 95% CI: 1.01 to 1.95) were associated with increased LOS. Atrial fibrillation was associated with 30-day rehospitalization (hazard ratio: 1.79; 95% CI: 1.22 to 2.63). CONCLUSIONS: Veterans undergoing TAVR at VA centers are predominantly elderly men with significant comorbidities. Clinical outcomes of mortality and rehospitalization at 30 days and 1-year mortality compare favorably with benchmark outcome data outside the VA. Published by Elsevier Inc.
OBJECTIVES: This study sought to describe clinical and procedural characteristics of veterans undergoing transcatheter aortic valve replacement (TAVR) within U.S. Department of Veterans Affairs (VA) centers and to examine their association with short- and long-term mortality, length of stay (LOS), and rehospitalization within 30 days. BACKGROUND: Veterans with severe aortic stenosis frequently undergo TAVR at VA medical centers. METHODS: Consecutive veterans undergoing TAVR between 2012 and 2017 were included. Patient and procedural characteristics were obtained from the VA Clinical Assessment, Reporting, and Tracking system. The primary outcomes were 30-day and 1-year survival, LOS >6 days, and rehospitalization within 30 days. Logistic regression and Cox proportional hazards analyses were performed to evaluate the associations between pre-procedural characteristics and LOS and rehospitalization. RESULTS: Nine hundred fifty-nine veterans underwent TAVR at 8 VA centers during the study period, 860 (90%) by transfemoral access, 50 (5%) transapical, 36 (3.8%) transaxillary, and 3 (0.3%) transaortic. Men predominated (939 of 959 [98%]), with an average age of 78.1 years. There were 28 deaths within 30 days (2.9%) and 134 at 1 year (14.0%). Median LOS was 5 days, and 141 veterans were rehospitalized within 30 days (14.7%). Nonfemoral access (odds ratio: 1.74; 95% confidence interval [CI]: 1.10 to 2.74), heart failure (odds ratio: 2.51; 95% CI: 1.83 to 3.44), and atrial fibrillation (odds ratio: 1.40; 95% CI: 1.01 to 1.95) were associated with increased LOS. Atrial fibrillation was associated with 30-day rehospitalization (hazard ratio: 1.79; 95% CI: 1.22 to 2.63). CONCLUSIONS: Veterans undergoing TAVR at VA centers are predominantly elderly men with significant comorbidities. Clinical outcomes of mortality and rehospitalization at 30 days and 1-year mortality compare favorably with benchmark outcome data outside the VA. Published by Elsevier Inc.
Authors: Laura J Damschroder; Andrew J Knighton; Emily Griese; Sarah M Greene; Paula Lozano; Amy M Kilbourne; Diana S M Buist; Karen Crotty; A Rani Elwy; Lee A Fleisher; Ralph Gonzales; Amy G Huebschmann; Heather M Limper; NithyaPriya S Ramalingam; Katherine Wilemon; P Michael Ho; Christian D Helfrichfcr Journal: Healthc (Amst) Date: 2021-06