A newly introduced quality improvement strategy significantly reduced 1-year all-cause mortality from 16.4% to 8.5% (OR 0.38) in patients undergoing transcatheter aortic valve replacement.
Cohort (n=806)
No
Does a quality improvement strategy reduce procedural, 30-day, and 1-year all-cause mortality in patients undergoing TAVR?
Implementation of a structured quality improvement strategy significantly reduced procedural, 30-day, and 1-year all-cause mortality in patients undergoing TAVR.
Odds Ratio: 0.38 (95% CI 0.24–0.61)
Absolute Event Rate: 8.5% vs 16.4%
p-value: p=<0.01
OBJECTIVE: The aim of this study is to assess the effects on procedural, 30-day, and 1‑year all-cause mortality by a newly introduced quality improvement strategy in patients after transcatheter aortic valve replacement (TAVR). METHODS: In October 2015, a coherent set of quality improving interventions with respect to patient geriatric screening, general diagnostic examination and safety of the procedure was implemented at a single centre in the Netherlands. Patients undergoing TAVR in 2013-2018 were included for retrospective analysis. Mortality was assessed in the pre-quality improvement strategy cohort (January 2013 to October 2015; cohort A) and in the post-quality improvement strategy cohort (November 2015 to December 2018; cohort B). Logistic regression analysis was used to estimate the influence of patient and procedural characteristics on the results of the quality improvement strategy in terms of procedural, 30-day, and 1‑year all-cause mortality. RESULTS: In total, 806 patients were analysed with 274 patients in cohort A and 532 patients in cohort B. After introduction of the quality improvement strategy, procedural (4.4% to 1.3%, p < 0.01), 30-day (8.4% to 2.7%, p < 0.01) and 1‑year (16.4% to 8.5%, p < 0.01) all-cause mortality significantly decreased. Multivariate regression analysis showed that the quality improvement strategy also significantly reduced 30-day (odds ratio OR 0.19, 95% confidence interval CI 0.09-0.42) and 1‑year (OR 0.38, 95% CI 0.24-0.61) all-cause mortality if corrected for patient characteristics. CONCLUSION: Structural meetings on evaluation of outcomes highlight potential areas for improvement and subsequent outcome-based quality improvement initiatives can result in lower procedural, 30-day, and 1‑year all-cause mortality.
Steenbergen et al. (Mon,) conducted a cohort in Severe aortic stenosis requiring transcatheter aortic valve replacement (TAVR) (n=806). Quality improvement strategy (pre-procedural assessment, geriatric screening, CT sizing, two operators for complex cases, local anesthesia, multidisciplinary evaluation) vs. Pre-quality improvement strategy cohort (standard care) was evaluated on 1-year all-cause mortality (OR 0.38, 95% CI 0.24-0.61, p=<0.01). A newly introduced quality improvement strategy significantly reduced 1-year all-cause mortality from 16.4% to 8.5% (OR 0.38) in patients undergoing transcatheter aortic valve replacement.