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Outcomes of Veterans Undergoing TAVR Within Veterans Affairs Medical Centers: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program.
- Source :
-
JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2019 Nov 11; Vol. 12 (21), pp. 2186-2194. Date of Electronic Publication: 2019 Aug 28. - Publication Year :
- 2019
-
Abstract
- Objectives: This 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.<br />Background: Veterans with severe aortic stenosis frequently undergo TAVR at VA medical centers.<br />Methods: Consecutive 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.<br />Results: Nine 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).<br />Conclusions: Veterans 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.<br /> (Published by Elsevier Inc.)
- Subjects :
- Age Factors
Aged
Aged, 80 and over
Aortic Valve diagnostic imaging
Aortic Valve physiopathology
Aortic Valve Stenosis diagnostic imaging
Aortic Valve Stenosis mortality
Aortic Valve Stenosis physiopathology
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
Treatment Outcome
United States
Veterans Health Services
Aortic Valve surgery
Aortic Valve Stenosis surgery
Transcatheter Aortic Valve Replacement adverse effects
Transcatheter Aortic Valve Replacement mortality
United States Department of Veterans Affairs
Subjects
Details
- Language :
- English
- ISSN :
- 1876-7605
- Volume :
- 12
- Issue :
- 21
- Database :
- MEDLINE
- Journal :
- JACC. Cardiovascular interventions
- Publication Type :
- Academic Journal
- Accession number :
- 31473239
- Full Text :
- https://doi.org/10.1016/j.jcin.2019.04.040