In-Hospital Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement in Relation to Heart Failure Status in the United States: An Analysis of the National Inpatient Sample

Abstract

Introduction Transcatheter aortic valve replacement (TAVR) is an increasingly common method of valve replacement in patients that are not candidates for open heart surgery. Although comorbid conditions are often present in these patients, there is a dearth of national studies evaluating outcomes in the presence of heart failure. We investigate whether systolic and diastolic heart failure impact hospital utilization and mortality. Methods The 2016 National Inpatient Sample (NIS) was used to find all patients that underwent TAVR in 2016, comparing those with systolic versus diastolic heart failure (Based on ICD-10-CM Codes). Patients with non-chronic forms of heart failure and those who received percutaneous endoscopic aortic valve replacement were excluded. STATA Version 15.1 (College Station, TX) was used for statistical analysis. Multivariate regression was used to calculate weighted nationwide estimates of hospital mortality, length of stay, and total charge. We adjusted for patient (age, sex, ethnicity, and Charlson Comorbidity Index), socioeconomic (median household income, insurance provider), and hospital factors (hospital bed size, region, teaching status, day and month of admission). Results An estimated 40,005 pts who underwent TAVR in 2016 were identified. Of those, 2475 had systolic heart failure and 7830 had diastolic heart failure. After adjusting for confounders, patients with systolic heart failure had longer median length of stay (Table 1) compared to those with diastolic heart failure (+0.483 days, p=0.013). In contrast, no significant differences were found between in hospital mortality (OR 1.32, p=0.565) and total hospital charge (+5324 USD, p=0534). Conclusion Our study is the first to show that there is no significant difference in in-hospital mortality in systolic versus diastolic heart failure patients undergoing TAVR. There was also no difference in total hospital cost between systolic and diastolic heart failure, whereas systolic heart failure was associated with an increased length of stay.