Regional Variation in Utilization, In-hospital Mortality, and Health-Care Resource Use of Transcatheter Aortic Valve Implantation in the United States

Tanush Gupta, Ankur Kalra, Dhaval Kolte, Sahil Khera, Pedro A. Villablanca, Kashish Goel, Anna E. Bortnick, Wilbert S. Aronow, Julio A. Panza, Neal S. Kleiman, J. Dawn Abbott, David P. Slovut, Cynthia C. Taub, Gregg C. Fonarow, Michael J. Reardon, Charanjit S. Rihal, Mario J. Garcia, Deepak L. Bhatt

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

We queried the National Inpatient Sample database from 2012 to 2014 to identify all patients aged ≥18 years undergoing transcatheter aortic valve implantation (TAVI) in the United States. Regional differences in TAVI utilization, in-hospital mortality, and health-care resource use were analyzed. Of 41,025 TAVI procedures in the United States between 2012 and 2014, 10,390 were performed in the Northeast, 9,090 in the Midwest, 14,095 in the South, and 7,450 in the West. Overall, the number of TAVI implants per million adults increased from 24.8 in 2012 to 63.2 in 2014. The utilization of TAVI increased during the study period in all 4 geographic regions, with the number of implants per million adults being highest in the Northeast, followed by the Midwest, South, and West, respectively. Overall in-hospital mortality was 4.2%. Compared with the Northeast, risk-adjusted in-hospital mortality was higher in the Midwest (adjusted odds ratio [aOR] 1.26 [1.07 to 1.48]) and the South (aOR 1.61 [1.40 to 1.85]) and similar in the West (aOR 1.00 [0.84 to 1.18]). Average length of stay was shorter in all other regions compared with the Northeast. Among patients surviving to discharge, disposition to a skilled nursing facility or home health care was most common in the Northeast, whereas home discharge was most common in the West. Average hospital costs were highest in the West. In conclusion, we observed significant regional differences in TAVI utilization, in-hospital mortality, and health-care resource use in the United States. The findings of our study may have important policy implications and should provide an impetus to understand the source of this regional variation.

Original languageEnglish (US)
JournalAmerican Journal of Cardiology
DOIs
StateAccepted/In press - 2017

Fingerprint

Health Resources
Hospital Mortality
Delivery of Health Care
Odds Ratio
Skilled Nursing Facilities
Hospital Costs
Home Care Services
Transcatheter Aortic Valve Replacement
Inpatients
Length of Stay
Databases

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Regional Variation in Utilization, In-hospital Mortality, and Health-Care Resource Use of Transcatheter Aortic Valve Implantation in the United States. / Gupta, Tanush; Kalra, Ankur; Kolte, Dhaval; Khera, Sahil; Villablanca, Pedro A.; Goel, Kashish; Bortnick, Anna E.; Aronow, Wilbert S.; Panza, Julio A.; Kleiman, Neal S.; Abbott, J. Dawn; Slovut, David P.; Taub, Cynthia C.; Fonarow, Gregg C.; Reardon, Michael J.; Rihal, Charanjit S.; Garcia, Mario J.; Bhatt, Deepak L.

In: American Journal of Cardiology, 2017.

Research output: Contribution to journalArticle

Gupta, T, Kalra, A, Kolte, D, Khera, S, Villablanca, PA, Goel, K, Bortnick, AE, Aronow, WS, Panza, JA, Kleiman, NS, Abbott, JD, Slovut, DP, Taub, CC, Fonarow, GC, Reardon, MJ, Rihal, CS, Garcia, MJ & Bhatt, DL 2017, 'Regional Variation in Utilization, In-hospital Mortality, and Health-Care Resource Use of Transcatheter Aortic Valve Implantation in the United States', American Journal of Cardiology. https://doi.org/10.1016/j.amjcard.2017.07.102
Gupta, Tanush ; Kalra, Ankur ; Kolte, Dhaval ; Khera, Sahil ; Villablanca, Pedro A. ; Goel, Kashish ; Bortnick, Anna E. ; Aronow, Wilbert S. ; Panza, Julio A. ; Kleiman, Neal S. ; Abbott, J. Dawn ; Slovut, David P. ; Taub, Cynthia C. ; Fonarow, Gregg C. ; Reardon, Michael J. ; Rihal, Charanjit S. ; Garcia, Mario J. ; Bhatt, Deepak L. / Regional Variation in Utilization, In-hospital Mortality, and Health-Care Resource Use of Transcatheter Aortic Valve Implantation in the United States. In: American Journal of Cardiology. 2017.
@article{cf2826e6c8114d9b8339fec0e642f18b,
title = "Regional Variation in Utilization, In-hospital Mortality, and Health-Care Resource Use of Transcatheter Aortic Valve Implantation in the United States",
abstract = "We queried the National Inpatient Sample database from 2012 to 2014 to identify all patients aged ≥18 years undergoing transcatheter aortic valve implantation (TAVI) in the United States. Regional differences in TAVI utilization, in-hospital mortality, and health-care resource use were analyzed. Of 41,025 TAVI procedures in the United States between 2012 and 2014, 10,390 were performed in the Northeast, 9,090 in the Midwest, 14,095 in the South, and 7,450 in the West. Overall, the number of TAVI implants per million adults increased from 24.8 in 2012 to 63.2 in 2014. The utilization of TAVI increased during the study period in all 4 geographic regions, with the number of implants per million adults being highest in the Northeast, followed by the Midwest, South, and West, respectively. Overall in-hospital mortality was 4.2{\%}. Compared with the Northeast, risk-adjusted in-hospital mortality was higher in the Midwest (adjusted odds ratio [aOR] 1.26 [1.07 to 1.48]) and the South (aOR 1.61 [1.40 to 1.85]) and similar in the West (aOR 1.00 [0.84 to 1.18]). Average length of stay was shorter in all other regions compared with the Northeast. Among patients surviving to discharge, disposition to a skilled nursing facility or home health care was most common in the Northeast, whereas home discharge was most common in the West. Average hospital costs were highest in the West. In conclusion, we observed significant regional differences in TAVI utilization, in-hospital mortality, and health-care resource use in the United States. The findings of our study may have important policy implications and should provide an impetus to understand the source of this regional variation.",
author = "Tanush Gupta and Ankur Kalra and Dhaval Kolte and Sahil Khera and Villablanca, {Pedro A.} and Kashish Goel and Bortnick, {Anna E.} and Aronow, {Wilbert S.} and Panza, {Julio A.} and Kleiman, {Neal S.} and Abbott, {J. Dawn} and Slovut, {David P.} and Taub, {Cynthia C.} and Fonarow, {Gregg C.} and Reardon, {Michael J.} and Rihal, {Charanjit S.} and Garcia, {Mario J.} and Bhatt, {Deepak L.}",
year = "2017",
doi = "10.1016/j.amjcard.2017.07.102",
language = "English (US)",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Regional Variation in Utilization, In-hospital Mortality, and Health-Care Resource Use of Transcatheter Aortic Valve Implantation in the United States

AU - Gupta, Tanush

AU - Kalra, Ankur

AU - Kolte, Dhaval

AU - Khera, Sahil

AU - Villablanca, Pedro A.

AU - Goel, Kashish

AU - Bortnick, Anna E.

AU - Aronow, Wilbert S.

AU - Panza, Julio A.

AU - Kleiman, Neal S.

AU - Abbott, J. Dawn

AU - Slovut, David P.

AU - Taub, Cynthia C.

AU - Fonarow, Gregg C.

AU - Reardon, Michael J.

AU - Rihal, Charanjit S.

AU - Garcia, Mario J.

AU - Bhatt, Deepak L.

PY - 2017

Y1 - 2017

N2 - We queried the National Inpatient Sample database from 2012 to 2014 to identify all patients aged ≥18 years undergoing transcatheter aortic valve implantation (TAVI) in the United States. Regional differences in TAVI utilization, in-hospital mortality, and health-care resource use were analyzed. Of 41,025 TAVI procedures in the United States between 2012 and 2014, 10,390 were performed in the Northeast, 9,090 in the Midwest, 14,095 in the South, and 7,450 in the West. Overall, the number of TAVI implants per million adults increased from 24.8 in 2012 to 63.2 in 2014. The utilization of TAVI increased during the study period in all 4 geographic regions, with the number of implants per million adults being highest in the Northeast, followed by the Midwest, South, and West, respectively. Overall in-hospital mortality was 4.2%. Compared with the Northeast, risk-adjusted in-hospital mortality was higher in the Midwest (adjusted odds ratio [aOR] 1.26 [1.07 to 1.48]) and the South (aOR 1.61 [1.40 to 1.85]) and similar in the West (aOR 1.00 [0.84 to 1.18]). Average length of stay was shorter in all other regions compared with the Northeast. Among patients surviving to discharge, disposition to a skilled nursing facility or home health care was most common in the Northeast, whereas home discharge was most common in the West. Average hospital costs were highest in the West. In conclusion, we observed significant regional differences in TAVI utilization, in-hospital mortality, and health-care resource use in the United States. The findings of our study may have important policy implications and should provide an impetus to understand the source of this regional variation.

AB - We queried the National Inpatient Sample database from 2012 to 2014 to identify all patients aged ≥18 years undergoing transcatheter aortic valve implantation (TAVI) in the United States. Regional differences in TAVI utilization, in-hospital mortality, and health-care resource use were analyzed. Of 41,025 TAVI procedures in the United States between 2012 and 2014, 10,390 were performed in the Northeast, 9,090 in the Midwest, 14,095 in the South, and 7,450 in the West. Overall, the number of TAVI implants per million adults increased from 24.8 in 2012 to 63.2 in 2014. The utilization of TAVI increased during the study period in all 4 geographic regions, with the number of implants per million adults being highest in the Northeast, followed by the Midwest, South, and West, respectively. Overall in-hospital mortality was 4.2%. Compared with the Northeast, risk-adjusted in-hospital mortality was higher in the Midwest (adjusted odds ratio [aOR] 1.26 [1.07 to 1.48]) and the South (aOR 1.61 [1.40 to 1.85]) and similar in the West (aOR 1.00 [0.84 to 1.18]). Average length of stay was shorter in all other regions compared with the Northeast. Among patients surviving to discharge, disposition to a skilled nursing facility or home health care was most common in the Northeast, whereas home discharge was most common in the West. Average hospital costs were highest in the West. In conclusion, we observed significant regional differences in TAVI utilization, in-hospital mortality, and health-care resource use in the United States. The findings of our study may have important policy implications and should provide an impetus to understand the source of this regional variation.

UR - http://www.scopus.com/inward/record.url?scp=85028626642&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85028626642&partnerID=8YFLogxK

U2 - 10.1016/j.amjcard.2017.07.102

DO - 10.1016/j.amjcard.2017.07.102

M3 - Article

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

ER -