Key result
AS interventions expanded as TAVI grew to ~43%, alongside falling in-hospital mortality for TAVI and SAVR.
Why the study?
Contemporary trends in aortic stenosis interventions in the USA needed assessment before and after the introduction of transcatheter aortic valve implantation.
What are the contemporary trends in the incidence, cost, and in-hospital outcomes of aortic stenosis interventions in the USA?
Observational
Yes
What are the contemporary trends in the incidence, cost, and in-hospital outcomes of aortic stenosis interventions in the USA?
The introduction of TAVI has led to a paradigm shift in aortic stenosis management in the USA, characterized by increasing intervention rates, rising costs, and improved in-hospital survival for both transcatheter and surgical approaches.
Declining mortality amid rising AS interventions supports broader access; leaves open questions on appropriateness and long-term net benefit.
AIMS: To assess the contemporary trends in aortic stenosis (AS) interventions in the USA before and after the introduction of transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS: We utilized the National-Inpatient-Sample to assess temporal trends in the incidence, cost, and outcomes of AS interventions between 1 January 2003 and 31 December 2016. During the study's period, AS interventions increased from 96 to 137 per 100 000 individuals > 60 years old, P < 0.001. In-hospital expenditure on AS interventions increased from $2.28 billion in 2003 to $4.33 in 2016 P < 0.001. Among patients who underwent aortic valve replacement, the proportion of TAVI increased from 11.9% in 2012 to 43.2% in 2016 (P < 0.001). Males and Hispanics had lower proportions of TAVI compared with females and White patients. Adjusted in-hospital mortality of isolated SAVR decreased from 5.4% in 2003 to 3.3% in 2016 (P < 0.001), whereas adjusted in-hospital mortality of TAVI decreased from 4.7% in 2012 to 2.2% in 2016, P < 0.001. The incidence of new dialysis, permanent pacemaker implantation, and blood transfusion decreased after both TAVI and SAVR between 2012 and 2016. However, the rate of post-operative stroke did not significantly decrease. Length of stay and cost of hospitalization decreased after both SAVR and TAVI, although the later remained higher with TAVI. Rates of non-home discharge decreased over time after TAVI but remained stable after isolated SAVR. 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.
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Alkhouli et al. (2019) conducted an observational in Aortic stenosis. Aortic stenosis interventions (TAVI and SAVR) vs. Historical trends was evaluated on Temporal trends in incidence, cost, and outcomes (including in-hospital mortality) (p=<0.001). Aortic stenosis interventions increased from 2003 to 2016, with TAVI accounting for 43.2% by 2016, alongside decreasing in-hospital mortality for both TAVI and SAVR (P<0.001).
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