Author + information
- Received May 28, 2019
- Revision received September 3, 2019
- Accepted September 18, 2019
- Published online December 2, 2019.
- Jennifer A. Rymer, MD, MBAa,b,∗ (, )
- Zhuokai Li, PhDb,
- Morgan L. Cox, MD, MHSc,
- Muath Bishawi, MDc,
- Andrzej S. Kosinski, PhDb,
- David J. Cohen, MD, MScd,
- Andrew Wang, MDa,
- Samir Kapadia, MDe,
- Paul Sorajja, MDf,
- John D. Carroll, MDg,
- Vinay Badhwar, MDh,
- Vinod Thourani, MDi,
- Donald D. Glower, MDc and
- Sreekanth Vemulapalli, MDa,b
- aDepartment of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina
- bDuke Clinical Research Institute, Durham, North Carolina
- cDepartment of Surgery, Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina
- dSaint Luke’s Mid America Heart Institute, University of Missouri–Kansas City, Kansas City, Missouri
- eCleveland Clinic Foundation, Cleveland, Ohio
- fValve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
- gUniversity of Colorado Anschutz Medical Campus, Aurora, Colorado
- hDepartment of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
- iDepartment of Cardiac Surgery, MedStar Heart and Vascular Institute/Georgetown University School of Medicine, Washington, District of Columbia
- ↵∗Address for correspondence:
Dr. Jennifer Rymer, Duke Clinical Research Institute, 300 W. Morgan Street, Durham, North Carolina 27701.
Objectives The aim of this study was to assess the real-world impact of transcatheter mitral valve repair (TMVR) on hospitalizations and Medicare costs pre- versus post-TMVR.
Background TMVR is effective in degenerative mitral regurgitation (MR) and appropriately selected patients with functional MR with high surgical risk.
Methods Patients undergoing TMVR in the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry from 2013 to 2018 were linked to Medicare claims data. Rates of hospitalizations, hospitalized days, and Medicare costs were compared 1-year pre-TMVR to 1-year post-TMVR.
Results Across 246 sites, 4,970 patients with a median age of 83 years (interquartile range: 77 to 87 years) were analyzed. The TMVR indication was degenerative MR in 77.5% and functional MR in 16.7%. From pre- to post-TMVR, heart failure (HF) hospitalization rates (479 vs. 370 hospitalizations/1,000 person-years; rate ratio [RR]: 0.77) and cardiovascular hospitalizations (838 vs. 632; RR: 0.75) decreased significantly (p < 0.001 for all). Similarly, the rates of hospitalized days decreased for HF and cardiovascular causes (p < 0.05 for all). Following TMVR, the odds of having no Medicare costs for HF hospitalizations increased (69% vs. 79%; odds ratio: 1.67; p < 0.001). However, the average total Medicare costs per day alive among patients with any HF hospitalizations after TMVR increased significantly (p < 0.001). The HF hospitalization rates decreased for patients with functional MR (683 vs. 502; RR: 0.74) and those with degenerative MR (431 vs. 337; RR: 0.78) (p < 0.001).
Conclusions TMVR is associated with a decrease in cardiovascular and HF hospitalizations and a greater likelihood of having no HF Medicare costs in the year after TMVR, regardless of MR etiology. Further work is necessary to elucidate the reasons for increased costs among patients with HF hospitalizations post-TMVR.
The Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry is an initiative of the Society of Thoracic Surgeons and the American College of Cardiology Foundation. This research was supported by the American College of Cardiology Foundation’s National Cardiovascular Data Registry and the Society of Thoracic Surgeons. Dr. Rymer has received research grant support from the American College of Cardiology, Boston Scientific, and Abbott Medical. Dr. Bishawi has received research grant support from Abbott Medical. Dr. Kosinski has received salary support from the Patient-Centered Outcomes Research Institute, the Society of Thoracic Surgeons, the Agency for Healthcare Research and Quality, the U.S. Department of Veterans Affairs, the American College of Cardiology, the American Heart Association, and the Marcus Foundation. Dr. Cohen has received research grant support from Abbott Vascular, Medtronic, Edwards Lifesciences, and Boston Scientific; and has received consulting income from Medtronic and Edwards Lifesciences. Dr. Wang receives research support from Abbott Medical. Dr. Sorajja has received consulting and research support from Abbott Medical, Edwards Lifesciences, Medtronic, and Boston Scientific; and has received consulting income from Gore and Admedus. Dr. Carroll is a committee member of the screening committee for the CLASP trial. Dr. Thourani has received grants from Edwards Lifesciences. Dr. Vemulapalli has received grant or contract support from the American College of Cardiology, the Society of Thoracic Surgeons, Abbott Vascular, Boston Scientific, the Patient-Centered Outcomes Research Institute, the National Institutes of Health, and HeartFlow; and is a consultant or advisory board member for Boston Scientific, Janssen, and Premiere. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 28, 2019.
- Revision received September 3, 2019.
- Accepted September 18, 2019.
- 2019 American College of Cardiology Foundation
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