Outcomes of Veterans Undergoing TAVR Within Veterans Affairs Medical Centers: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program

Philip S. Hall, Colin I. O'Donnell, Verghese Mathew, Santiago Garcia, Anthony A. Bavry, Subhash Banerjee, Hani Jneid, Ali E. Denktas, John C. Giacomini, Paul M. Grossman, Kul Aggarwal, Jeffrey M. Zimmet, Elaine E. Tseng, Leo Gozdecki, Lucas Burke, Stefan C. Bertog, Maurice Buchbinder, Mary E. Plomondon, Stephen W. Waldo, Kendrick A. Shunk

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objectives: This study sought to describe clinical and procedural characteristics of veterans undergoing transcatheter aortic valve replacement (TAVR) within U.S. Department of Veterans Affairs (VA) centers and to examine their association with short- and long-term mortality, length of stay (LOS), and rehospitalization within 30 days. Background: Veterans with severe aortic stenosis frequently undergo TAVR at VA medical centers. Methods: Consecutive veterans undergoing TAVR between 2012 and 2017 were included. Patient and procedural characteristics were obtained from the VA Clinical Assessment, Reporting, and Tracking system. The primary outcomes were 30-day and 1-year survival, LOS >6 days, and rehospitalization within 30 days. Logistic regression and Cox proportional hazards analyses were performed to evaluate the associations between pre-procedural characteristics and LOS and rehospitalization. Results: Nine hundred fifty-nine veterans underwent TAVR at 8 VA centers during the study period, 860 (90%) by transfemoral access, 50 (5%) transapical, 36 (3.8%) transaxillary, and 3 (0.3%) transaortic. Men predominated (939 of 959 [98%]), with an average age of 78.1 years. There were 28 deaths within 30 days (2.9%) and 134 at 1 year (14.0%). Median LOS was 5 days, and 141 veterans were rehospitalized within 30 days (14.7%). 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) were associated with increased LOS. Atrial fibrillation was associated with 30-day rehospitalization (hazard ratio: 1.79; 95% CI: 1.22 to 2.63). Conclusions: Veterans undergoing TAVR at VA centers are predominantly elderly men with significant comorbidities. Clinical outcomes of mortality and rehospitalization at 30 days and 1-year mortality compare favorably with benchmark outcome data outside the VA.

Original languageEnglish (US)
Pages (from-to)2186-2194
Number of pages9
JournalJACC: Cardiovascular Interventions
Volume12
Issue number21
DOIs
StatePublished - Nov 11 2019

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Veterans
Length of Stay
Confidence Intervals
Odds Ratio
Atrial Fibrillation
Mortality
Transcatheter Aortic Valve Replacement
Benchmarking
United States Department of Veterans Affairs
Aortic Valve Stenosis
Comorbidity
Heart Failure
Logistic Models
Survival

Keywords

  • aortic stenosis
  • transcatheter aortic valve replacement
  • veterans

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Outcomes of Veterans Undergoing TAVR Within Veterans Affairs Medical Centers : Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. / Hall, Philip S.; O'Donnell, Colin I.; Mathew, Verghese; Garcia, Santiago; Bavry, Anthony A.; Banerjee, Subhash; Jneid, Hani; Denktas, Ali E.; Giacomini, John C.; Grossman, Paul M.; Aggarwal, Kul; Zimmet, Jeffrey M.; Tseng, Elaine E.; Gozdecki, Leo; Burke, Lucas; Bertog, Stefan C.; Buchbinder, Maurice; Plomondon, Mary E.; Waldo, Stephen W.; Shunk, Kendrick A.

In: JACC: Cardiovascular Interventions, Vol. 12, No. 21, 11.11.2019, p. 2186-2194.

Research output: Contribution to journalArticle

Hall, PS, O'Donnell, CI, Mathew, V, Garcia, S, Bavry, AA, Banerjee, S, Jneid, H, Denktas, AE, Giacomini, JC, Grossman, PM, Aggarwal, K, Zimmet, JM, Tseng, EE, Gozdecki, L, Burke, L, Bertog, SC, Buchbinder, M, Plomondon, ME, Waldo, SW & Shunk, KA 2019, 'Outcomes of Veterans Undergoing TAVR Within Veterans Affairs Medical Centers: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program', JACC: Cardiovascular Interventions, vol. 12, no. 21, pp. 2186-2194. https://doi.org/10.1016/j.jcin.2019.04.040
Hall, Philip S. ; O'Donnell, Colin I. ; Mathew, Verghese ; Garcia, Santiago ; Bavry, Anthony A. ; Banerjee, Subhash ; Jneid, Hani ; Denktas, Ali E. ; Giacomini, John C. ; Grossman, Paul M. ; Aggarwal, Kul ; Zimmet, Jeffrey M. ; Tseng, Elaine E. ; Gozdecki, Leo ; Burke, Lucas ; Bertog, Stefan C. ; Buchbinder, Maurice ; Plomondon, Mary E. ; Waldo, Stephen W. ; Shunk, Kendrick A. / Outcomes of Veterans Undergoing TAVR Within Veterans Affairs Medical Centers : Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. In: JACC: Cardiovascular Interventions. 2019 ; Vol. 12, No. 21. pp. 2186-2194.
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title = "Outcomes of Veterans Undergoing TAVR Within Veterans Affairs Medical Centers: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program",
abstract = "Objectives: This study sought to describe clinical and procedural characteristics of veterans undergoing transcatheter aortic valve replacement (TAVR) within U.S. Department of Veterans Affairs (VA) centers and to examine their association with short- and long-term mortality, length of stay (LOS), and rehospitalization within 30 days. Background: Veterans with severe aortic stenosis frequently undergo TAVR at VA medical centers. Methods: Consecutive veterans undergoing TAVR between 2012 and 2017 were included. Patient and procedural characteristics were obtained from the VA Clinical Assessment, Reporting, and Tracking system. The primary outcomes were 30-day and 1-year survival, LOS >6 days, and rehospitalization within 30 days. Logistic regression and Cox proportional hazards analyses were performed to evaluate the associations between pre-procedural characteristics and LOS and rehospitalization. Results: Nine hundred fifty-nine veterans underwent TAVR at 8 VA centers during the study period, 860 (90{\%}) by transfemoral access, 50 (5{\%}) transapical, 36 (3.8{\%}) transaxillary, and 3 (0.3{\%}) transaortic. Men predominated (939 of 959 [98{\%}]), with an average age of 78.1 years. There were 28 deaths within 30 days (2.9{\%}) and 134 at 1 year (14.0{\%}). Median LOS was 5 days, and 141 veterans were rehospitalized within 30 days (14.7{\%}). 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) were associated with increased LOS. Atrial fibrillation was associated with 30-day rehospitalization (hazard ratio: 1.79; 95{\%} CI: 1.22 to 2.63). Conclusions: Veterans undergoing TAVR at VA centers are predominantly elderly men with significant comorbidities. Clinical outcomes of mortality and rehospitalization at 30 days and 1-year mortality compare favorably with benchmark outcome data outside the VA.",
keywords = "aortic stenosis, transcatheter aortic valve replacement, veterans",
author = "Hall, {Philip S.} and O'Donnell, {Colin I.} and Verghese Mathew and Santiago Garcia and Bavry, {Anthony A.} and Subhash Banerjee and Hani Jneid and Denktas, {Ali E.} and Giacomini, {John C.} and Grossman, {Paul M.} and Kul Aggarwal and Zimmet, {Jeffrey M.} and Tseng, {Elaine E.} and Leo Gozdecki and Lucas Burke and Bertog, {Stefan C.} and Maurice Buchbinder and Plomondon, {Mary E.} and Waldo, {Stephen W.} and Shunk, {Kendrick A.}",
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TY - JOUR

T1 - Outcomes of Veterans Undergoing TAVR Within Veterans Affairs Medical Centers

T2 - Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program

AU - Hall, Philip S.

AU - O'Donnell, Colin I.

AU - Mathew, Verghese

AU - Garcia, Santiago

AU - Bavry, Anthony A.

AU - Banerjee, Subhash

AU - Jneid, Hani

AU - Denktas, Ali E.

AU - Giacomini, John C.

AU - Grossman, Paul M.

AU - Aggarwal, Kul

AU - Zimmet, Jeffrey M.

AU - Tseng, Elaine E.

AU - Gozdecki, Leo

AU - Burke, Lucas

AU - Bertog, Stefan C.

AU - Buchbinder, Maurice

AU - Plomondon, Mary E.

AU - Waldo, Stephen W.

AU - Shunk, Kendrick A.

PY - 2019/11/11

Y1 - 2019/11/11

N2 - Objectives: This study sought to describe clinical and procedural characteristics of veterans undergoing transcatheter aortic valve replacement (TAVR) within U.S. Department of Veterans Affairs (VA) centers and to examine their association with short- and long-term mortality, length of stay (LOS), and rehospitalization within 30 days. Background: Veterans with severe aortic stenosis frequently undergo TAVR at VA medical centers. Methods: Consecutive veterans undergoing TAVR between 2012 and 2017 were included. Patient and procedural characteristics were obtained from the VA Clinical Assessment, Reporting, and Tracking system. The primary outcomes were 30-day and 1-year survival, LOS >6 days, and rehospitalization within 30 days. Logistic regression and Cox proportional hazards analyses were performed to evaluate the associations between pre-procedural characteristics and LOS and rehospitalization. Results: Nine hundred fifty-nine veterans underwent TAVR at 8 VA centers during the study period, 860 (90%) by transfemoral access, 50 (5%) transapical, 36 (3.8%) transaxillary, and 3 (0.3%) transaortic. Men predominated (939 of 959 [98%]), with an average age of 78.1 years. There were 28 deaths within 30 days (2.9%) and 134 at 1 year (14.0%). Median LOS was 5 days, and 141 veterans were rehospitalized within 30 days (14.7%). 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) were associated with increased LOS. Atrial fibrillation was associated with 30-day rehospitalization (hazard ratio: 1.79; 95% CI: 1.22 to 2.63). Conclusions: Veterans undergoing TAVR at VA centers are predominantly elderly men with significant comorbidities. Clinical outcomes of mortality and rehospitalization at 30 days and 1-year mortality compare favorably with benchmark outcome data outside the VA.

AB - Objectives: This study sought to describe clinical and procedural characteristics of veterans undergoing transcatheter aortic valve replacement (TAVR) within U.S. Department of Veterans Affairs (VA) centers and to examine their association with short- and long-term mortality, length of stay (LOS), and rehospitalization within 30 days. Background: Veterans with severe aortic stenosis frequently undergo TAVR at VA medical centers. Methods: Consecutive veterans undergoing TAVR between 2012 and 2017 were included. Patient and procedural characteristics were obtained from the VA Clinical Assessment, Reporting, and Tracking system. The primary outcomes were 30-day and 1-year survival, LOS >6 days, and rehospitalization within 30 days. Logistic regression and Cox proportional hazards analyses were performed to evaluate the associations between pre-procedural characteristics and LOS and rehospitalization. Results: Nine hundred fifty-nine veterans underwent TAVR at 8 VA centers during the study period, 860 (90%) by transfemoral access, 50 (5%) transapical, 36 (3.8%) transaxillary, and 3 (0.3%) transaortic. Men predominated (939 of 959 [98%]), with an average age of 78.1 years. There were 28 deaths within 30 days (2.9%) and 134 at 1 year (14.0%). Median LOS was 5 days, and 141 veterans were rehospitalized within 30 days (14.7%). 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) were associated with increased LOS. Atrial fibrillation was associated with 30-day rehospitalization (hazard ratio: 1.79; 95% CI: 1.22 to 2.63). Conclusions: Veterans undergoing TAVR at VA centers are predominantly elderly men with significant comorbidities. Clinical outcomes of mortality and rehospitalization at 30 days and 1-year mortality compare favorably with benchmark outcome data outside the VA.

KW - aortic stenosis

KW - transcatheter aortic valve replacement

KW - veterans

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