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TAVR model reveals differences in hospital outcomes

Presented by
Dr N. Desai, Hospital of the University of Pennsylvania, USA
ACC 2020
STS/ACC TVT Registry
A novel, patient-centric, composite-outcome model for transcatheter aortic valve replacement (TAVR) based on 30-day outcomes and their ranked association with both 1-year mortality and quality of life has shown significant site-level variation in mortality and major complications after TAVR procedures in the United States [1].

Dr Nimesh Desai (Hospital of the University of Pennsylvania, USA) presented the results of the STS/ACC TVT Registry. The purpose of the study was to determine whether site-level variation exists in TAVR quality of care in the USA using a novel, patient-centric, 30-day, composite-outcome measure, comparing each hospital to the national average. The patient cohort consisted of patients who underwent transfemoral TAVR for symptomatic aortic stenosis between 1 January 2015 and 31 December 2017. Data from hospitals with >10% missing data for the outcome variable and other key study variables was excluded. A ranked composite outcome selection was developed consisting of periprocedural complications determined by their adjusted association with 1-year mortality and patient quality of life, based on the Kansas City Cardiomyopathy Questionnaire (KCCQ); and any outcome with significant hazard ratio was maintained. When ranking the endpoints, the outcome with the highest rank was assigned if patients had more than 1 outcome. The overall model was a hierarchical, multi-category, logistic regression model that estimates a set of hospital-specific odds ratios. Site difference was defined as a random patient doing worse at an average hospital and a random patient doing better at an average hospital.

It emerged that 11% of the 301 included sites performed worse than expected, 80% performed as expected, and 8% better than expected. The reliability of the model was tested, and it showed moderate-to-high reliability even when including lower-volume programmes. However, the researchers acknowledged that the analysis had its limitations including that it did not examine the quality of care of patients who underwent TAVR using non-femoral access as well as missing baseline KCCQ-12 and gait speed data, which limited the number of sites included in this analysis. The steering committee of the STS/ACC TVT registry commissioned the composite metric, said Dr Desai, and it has already been approved for use.

    1. Desai N, et al. Abstract 405-12. ACC/WCC 28-30 March 2020.


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