1. Outcomes of Veterans Undergoing TAVR Within Veterans Affairs Medical Centers Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program
- Author
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Hall, Philip S, O'Donnell, Colin I, Mathew, Verghese, Garcia, Santiago, Bavry, Anthony A, Banerjee, Subhash, Jneid, Hani, Denktas, Ali E, Giacomini, John C, Grossman, Paul M, Aggarwal, Kul, Zimmet, Jeffrey M, Tseng, Elaine E, Gozdecki, Leo, Burke, Lucas, Bertog, Stefan C, Buchbinder, Maurice, Plomondon, Mary E, Waldo, Stephen W, and Shunk, Kendrick A
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Heart Disease ,Clinical Research ,Cardiovascular ,Transplantation ,Patient Safety ,Good Health and Well Being ,Age Factors ,Aged ,Aged ,80 and over ,Aortic Valve ,Aortic Valve Stenosis ,Comorbidity ,Female ,Humans ,Length of Stay ,Male ,Outcome and Process Assessment ,Health Care ,Patient Readmission ,Program Evaluation ,Risk Assessment ,Risk Factors ,Sex Factors ,Time Factors ,Transcatheter Aortic Valve Replacement ,Treatment Outcome ,United States ,United States Department of Veterans Affairs ,Veterans Health Services ,aortic stenosis ,transcatheter aortic valve replacement ,veterans ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology - Abstract
ObjectivesThis study sought to describe clinical and procedural characteristics of veterans undergoing transcatheter aortic valve replacement (TAVR) within U.S. Department of Veterans Affairs (VA) centers and to examine their association with short- and long-term mortality, length of stay (LOS), and rehospitalization within 30 days.BackgroundVeterans with severe aortic stenosis frequently undergo TAVR at VA medical centers.MethodsConsecutive veterans undergoing TAVR between 2012 and 2017 were included. Patient and procedural characteristics were obtained from the VA Clinical Assessment, Reporting, and Tracking system. The primary outcomes were 30-day and 1-year survival, LOS >6 days, and rehospitalization within 30 days. Logistic regression and Cox proportional hazards analyses were performed to evaluate the associations between pre-procedural characteristics and LOS and rehospitalization.ResultsNine hundred fifty-nine veterans underwent TAVR at 8 VA centers during the study period, 860 (90%) by transfemoral access, 50 (5%) transapical, 36 (3.8%) transaxillary, and 3 (0.3%) transaortic. Men predominated (939 of 959 [98%]), with an average age of 78.1 years. There were 28 deaths within 30 days (2.9%) and 134 at 1 year (14.0%). Median LOS was 5 days, and 141 veterans were rehospitalized within 30 days (14.7%). Nonfemoral access (odds ratio: 1.74; 95% confidence interval [CI]: 1.10 to 2.74), heart failure (odds ratio: 2.51; 95% CI: 1.83 to 3.44), and atrial fibrillation (odds ratio: 1.40; 95% CI: 1.01 to 1.95) were associated with increased LOS. Atrial fibrillation was associated with 30-day rehospitalization (hazard ratio: 1.79; 95% CI: 1.22 to 2.63).ConclusionsVeterans undergoing TAVR at VA centers are predominantly elderly men with significant comorbidities. Clinical outcomes of mortality and rehospitalization at 30 days and 1-year mortality compare favorably with benchmark outcome data outside the VA.
- Published
- 2019