RALEIGH, NC—How do veterans fare when they undergo transcatheter aortic valve replacement with the VA? That was the question asked by a study which sought to examine their association with short- and long-term mortality, length of stay, and rehospitalization within 30 days.
The report in JACC: Cardiovascular Interventions focused on veterans with severe aortic stenosis, who frequently undergo TAVR at VAMCs. The research, led by University of North Carolina Rex Healthcare investigators, involved VA centers in Aurora, CO; Minneapolis; Gainesville, FL; Dallas; Houston; Palo Alto, CA; Ann Arbor, MI; Columbia, MO; and San Francisco.1
Included in the study were consecutive veteran patients undergoing TAVR between 2012 and 2017. The study team obtained patient and procedural characteristics from the VA Clinical Assessment, Reporting and Tracking system. Defined as primary outcomes were 30-day and 1-year survival, LOS >6 days, and rehospitalization within 30 days.
Overall, 959 veterans underwent TAVR at eight VAMCs during the study period, 860 (90%) by transfemoral access, 50 (5%) transapical, 36 (3.8%) transaxillary, and 3 (0.3%) transaortic. Most, 98%, were men, with an average age of 78.1 years.
Researchers documented 28 deaths within 30 days (2.9%) and 134 at a year (14.0%). Median LOS was calculated at five days and 141 veterans were rehospitalized within 30 days (14.7%).
Associated with increased LOS were:
- 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).
Atrial fibrillation also was associated with 30-day rehospitalization (hazard ratio: 1.79; 95% CI: 1.22 to 2.63), the study found.
“Veterans undergoing TAVR at VA centers are predominantly elderly men with significant comorbidities,” study authors concluded. “Clinical outcomes of mortality and rehospitalization at 30 days and 1-year mortality compare favorably with benchmark outcome data outside the VA.”
- Hall PS, O’Donnell CI, Mathew V, Garcia S, Bavry AA, et. Al. Outcomes of Veterans Undergoing TAVR Within Veterans Affairs Medical Centers: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. JACC Cardiovasc Interv. 2019 Aug 22. pii: S1936-8798(19)31021-0. doi:10.1016/j.jcin.2019.04.040. [Epub ahead of print] PubMed PMID: 31473239.