Temporal Changes in Quality Indicators in a Regional System of Care After Surgical and Transcatheter Aortic Valve Replacement.

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Version: Final published version
License: CC BY-NC-ND 4.0
Serval ID
serval:BIB_CD1CF610D64E
Type
Article: article from journal or magazin.
Collection
Publications
Title
Temporal Changes in Quality Indicators in a Regional System of Care After Surgical and Transcatheter Aortic Valve Replacement.
Journal
CJC open
Author(s)
Lauck S.B., Yu M., Pu A., Virani S., Meier D., Akodad M., Sathananthan J., Chan A.W., Price J., Wong D., Wood D.A., Webb J.G., Abel J.G.
ISSN
2589-790X (Electronic)
ISSN-L
2589-790X
Publication state
Published
Issued date
07/2023
Peer-reviewed
Oui
Volume
5
Number
7
Pages
508-521
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
Historically, quality-of-care monitoring was performed separately for transcatheter and surgical aortic valve replacement (TAVR, SAVR). Using consensus indicators, we provide a global report on the quality of care for treatment of aortic stenosis across the highest-volume treatments: transfemoral (TF) TAVR, isolated SAVR, and SAVR combined with coronary artery bypass graft.
Retrospective observational cohort study of consecutive patients in a regional system of care. Primary endpoint was 30-day and 1-year mortality (2015-2019). Secondary endpoints included rate of new pacemaker, rate of readmission, and length of stay (2012-2019). Following multivariable logistic regressions, we developed mortality case-mix adjustment models to report risk estimates.
The proportion of patients receiving TAVR grew from 32% to 53% (2015-2019). Those receiving TF TAVR were significantly older, with higher rates of comorbidities. Observed 30-day and 1-year all-cause mortality after TF TAVR decreased from 3.1% to 0.6% (P = 0.03), and 13.6% to 6.6% (P = 0.09), respectively; surgical mortality rates for isolated SAVR and SAVR combined with coronary artery bypass graft were low and did not change significantly over time, ranging from 0.3% to 1.4% and from 0.9% to 3.4%, respectively at 30 days, and from 0.9% to 3.4% and from 4.7% to 6.7 at 1 year. In the TF TAVR cohort, the observed vs expected ratio for 30-day and 1-year mortality decreased significantly from 1.9 (95% confidence interval [CI] 0.9, 3.5) to 0.3 (95% CI 0.1, 0.8), and from 1.3 (95% CI 0.9, 1.7) to 0.7 (95% CI 0.5, 0.99), respectively; no change occurred in risk-adjusted surgical mortality.
Consensus quality indicators provide unique insights on the quality of care for patients receiving treatment for aortic stenosis.
Pubmed
Web of science
Open Access
Yes
Create date
17/01/2025 5:36
Last modification date
24/02/2025 14:27
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