The following is the summary of “Days at home after transcatheter or surgical aortic valve replacement in high-risk patients” published in the January 2023 issue of Heart by Chung, et al.
Time spent at home following a medical procedure or emergency has been quantified by days at home (DAH), although DAH has not been thoroughly examined for TAVR. Among high-risk patients in a randomized trial of transcatheter aortic valve replacement (TAVR) with a self-expanding bioprosthesis versus surgical aortic valve replacement (SAVR), researchers aimed to assess 1- and 5-year DAH (DAH365, DAH1825). For a total of 456 patients, researchers matched data from the U.S. CoreValve High-Risk Trial to Medicare Fee-for-Service claims, with 1-year outcomes assessed for 450 (234 TAVR/216 SAVR) and 5-year outcomes analyzed for 427 (222 TAVR/205 SAVR). DAH was determined as the sum of all days the patient was alive and not in a healthcare facility (such as a hospital, nursing home, rehabilitation center, long-term acute care hospital, emergency room, or observation unit).
Patients who underwent TAVR had a longer mean DAH365 than those who received SAVR (295.1± 106.9 vs. 267.8 ± 122.3, difference in days 27.2 [95% CI 6.0, 48.5], P=.01). Patients who underwent TAVR had a shorter index length of stay (LOS) than those who underwent SAVR (7.4 ± 4.5 days vs. 12.5 ± 9.0 days, the difference in days -5.1 [-6.5, -3.8], P<.001). ± Mortality days and total facility days after the index hospitalization were the largest contributors to reduced DAH365 (mortality days-TAVR: 34.7± 93.1 vs. SAVR: 48.0 ± 108.8, the difference in days -13.3 [95% CI -32.1, 5.5], P=.17; total facility days-TAVR: 27.9 ± 47.4 vs. SAVR: 36.7 ± the 48.9, the difference in days 8. In terms of DAH1825, TAVR was quantitatively better than SAVR (TAVR: 1154.2 ± 659.0 vs. SAVR: 1067.6 ± 697.3, the difference in days 86.6 [95% CI -42.3, 215.6], P=.19). From year 1 to year 5, the DAH for TAVR and SAVR were both similar at 1040.4 ± 477.5 (TAVR) and 1022.9 ± 489.3 (SAVR), respectively (P=.74 for the landmark analysis).
With a shorter index LOS and the additive effect of fewer, but not significantly different mortality and total facility days after discharge from the index hospitalization, high-risk patients undergoing TAVR spend an average of 27 more DAH than those undergoing SAVR in the first year following the procedure, according to the Medicare-affiliated U.S. CoreValve High-Risk Trial. Expenditures in DAH are roughly the same for both categories after the first year. These findings provide a patient-centered account of the post-procedural course of high-risk patients, with implications for informing shared decision-making and guiding expectations for the duration of necessary medical care.
Source: sciencedirect.com/science/article/abs/pii/S0002870322002757