The Evolving Management of Aortic Valve Disease: 5-Year Trends in SAVR, TAVR, and Medical Therapy

被引:46
作者
Goldsweig, Andrew M. [1 ]
Tak, Hyo Jung [2 ]
Chen, Li-Wu [2 ]
Aronow, Herbert D. [3 ,4 ]
Shah, Binita [5 ,6 ]
Kolte, Dhaval S. [7 ,8 ]
Velagapudi, Poonam [1 ]
Desai, Nihar [9 ,10 ]
Szerlip, Molly [11 ]
Abbott, J. Dawn [3 ,4 ]
机构
[1] Univ Nebraska Med Ctr, Div Cardiovasc Med, Omaha, NE 68198 USA
[2] Univ Nebraska Med Ctr, Dept Hlth Serv Res & Adm, Omaha, NE USA
[3] Brown Univ, Div Cardiovasc Med, Providence, RI 02912 USA
[4] Lifespan Cardiovasc Inst, Providence, RI USA
[5] VA New York Harbor Healthcare, Div Cardiol, New York, NY USA
[6] NYU, Sch Med, New York, NY USA
[7] Harvard Univ, Div Cardiovasc Med, Boston, MA 02115 USA
[8] Massachusetts Gen Hosp, Boston, MA 02115 USA
[9] Yale Univ, Div Cardiovasc Med, New Haven, CT USA
[10] Yale New Haven Med Ctr, 20 York St, New Haven, CT 06504 USA
[11] Heart Hosp, Baylor Plano, Dept Intervent Cardiol, Plano, TX USA
关键词
IN-HOSPITAL OUTCOMES; TRANSCATHETER; REPLACEMENT; IMPLANTATION; STENOSIS;
D O I
10.1016/j.amjcard.2019.05.044
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aortic stenosis (AS) and regurgitation (AR) may be treated with surgical aortic valve replacement (SAVR), transcatheter AVR (TAVR), or medical therapy (MT). Data are lacking regarding the usage of SAVR, TAVR, and MT for patients hospitalized with aortic valve disease and the characteristics of the patients and hospitals associated with each therapy. From the Nationwide Readmissions Database, we determined utilization trends for SAVR, TAVR, and MT in patients with aortic valve disease admitted from 2012 to 2016 for valve replacement, heart failure, unstable angina, non-ST-elevation myocardial infarction, or syncope. We also performed multinomial logistic regressions to investigate associations between patient and hospital characteristics and treatment. Among 366,909 patients hospitalized for aortic valve disease, there was a 48.1% annual increase from 2012 through 2016. Overall, 19.9%, 6.7%, and 73.4% of patients received SAVR, TAVR, and MT, respectively. SAVR decreased from 21.9% in 2012 to 18.5% in 2016, whereas TAVR increased from 2.6% to 12.5%, and MT decreased from 75.5% to 69.0%. Older age, female sex, greater severity of illness, more admission diagnoses, not-for-profit hospitals, large hospitals, and urban teaching hospitals were associated with greater use of TAVR. In multivariable analysis, likelihood of TAVR relative to SAVR increased 4.57-fold (95% confidence interval 4.21 to 4.97). TAVR has increased at the expense of both SAVR and MT, a novel finding. However, this increase in TAVR was distributed inequitably, with certain patients more likely to receive TAVR certain hospitals more likely to provide TAVR. With the expected expansion of indications, inequitable access to TAVR must be addressed. (C) 2019 Elsevier Inc. All rights reserved.
引用
收藏
页码:763 / 771
页数:9
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