In-Hospital Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement in Relation to the Presence of Heart Failure 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. As TAVR is reserved for patients with intermediate risk, most patients who undergo TAVR are older. 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 the presence of heart failure impacts 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 to those without heart failure (based on ICD-10-CM Codes). The codes for chronic systolic and diastolic heart failure were used, in addition to the code for combined systolic and diastolic heart failure to create a subgroup of heart failure patients. The codes for percutaneous endoscopic aortic valve replacement and other non-chronic forms of heart failure 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 A total of 40,005 patients who underwent TAVR in 2016 were identified. Of those, 12,080 had chronic heart failure. There was a significantly decreased length of stay (coefficient -1.97, p=0.000), total hospital cost (coefficient= -20685.16, p=0.000), and mortality (OR: 0.453, p=0.001) in patients with heart failure undergoing TAVR when compared to those without (Table 1). Conclusion Our study was the first to show decreased total hospital cost, length of stay, and in-hospital mortality among heart failure patients undergoing TAVR compared to those without heart failure. Further studies are required to elucidate the etiology of this difference.