Valvular & structural heart diseaseCohort study
Contemporary trends in the management of aortic stenosis in the USA
- Retrospective cohort study
- nationwide
- National Inpatient Sample
Authors' conclusion
This nationwide survey documents the increasing incidence of AS interventions, the rising cost of modern AS care, and the paradigm shift in aortic valve replacement practice in the USA.
Study context
- Population
- Patients undergoing aortic stenosis (AS) interventions in the US, National Inpatient Sample, 2003–2016
- Exposure
- Temporal trends in AS interventions, 2003–2016
Main finding
As reported in the abstract
AS interventions per 100 000 individuals > 60 years old, start vs end of study period
96 to 137, P < 0.001
In-hospital expenditure on AS interventions, 2003 vs 2016
$2.28 billion to $4.33, P < 0.001
Proportion of transcatheter aortic valve implantation (TAVI) among aortic valve replacements, 2012 vs 2016
11.9% to 43.2% (P < 0.001)
Observational data: associations, not effects.
Further findings
Adjusted in-hospital mortality
- Isolated SAVR, 2003 to 2016
- 5.4% to 3.3%, P < 0.001
- TAVI, 2012 to 2016
- 4.7% to 2.2%, P < 0.001
TAVI use by sex and ethnicity
- Males and Hispanics had lower proportions of TAVI than females and White patients
Length of stay and hospitalization cost
- Decreased after both SAVR and TAVI; remained higher with TAVI
Non-home discharge
- Decreased over time after TAVI; stable after isolated SAVR
Safety
New dialysis, permanent pacemaker implantation, blood transfusion, post-operative stroke · 2012–2016
- New dialysis, permanent pacemaker and blood transfusion decreased after both TAVI and SAVR
- Post-operative stroke did not significantly decrease
Original publication
Summarised from the published abstract; every number is checked against it