Comparison of 1 year pre- and post-transcatheter aortic valve replacement hospitalization rates: a population-based cohort study
Czarnecki A, Qiu F, Henning KA, Fang J, Jennett M, Austin PC, Ko DT, Radhakrishnan S, Wijeysundera HC. Can J Cardiol. 2020; 36(10):1616-23. Epub 2020 Jan 20. DOI: https://doi.org/10.1016/j.cjca.2020.01.009
Background — Rehospitalization rates post transcatheter aortic valve replacement (TAVR) are high; however, it is not known how these compare to pre-TAVR hospitalization rates. Our objective was to determine the association between the index TAVR and hospitalization rates pre- and post-procedure.
Methods — A retrospective observational study was performed including all TAVR procedures performed in Ontario, Canada between 2013 and 2017. Patients who died during the index hospitalization were excluded. The primary outcome was all-cause hospitalization within 1 year of TAVR discharge. Hospitalization rates per person-year were calculated and compared for each of the following analogous time periods pre- and post-index TAVR: 1 – 30, 31 – 90, 91 – 365, and 1 – 365 days. Poisson regression models were used to generate rate ratios to compare hospitalization rates.
Results — The final study cohort included 2,547 patients. In the year before TAVR, 60.2% of patients were hospitalized, as compared to 45.9% in the year following the procedure. The rate ratio (RR) for the year post-TAVR as compared to pre-TAVR was 0.82 (95% CI 0.77 – 0.88). When comparing each parallel time period post- versus pre-TAVR, all intervals were associated with significant reductions in hospitalization after TAVR, except the 30-day peri-procedural period. The largest change in hospitalization rates occurred in the 31 to 90 days post- versus the corresponding period pre-TAVR (RR 0.57; 95% CI 0.50 – 0.64)
Conclusion — TAVR is associated with a significant and sustained reduction in all-cause hospitalization in the year following the procedure, when compared to the pre-procedural period.