The U.S. trials for transcatheter aortic valve replacement (TAVR) are unusual in that they started with the sickest patients and then began working their way down the risk scale. As studies shift to lower-risk patients, issues such as cost and durability rise to the forefront.
Our cover story looks at TAVR-related complications and outcomes. In general, complications have decreased with greater understanding of the devices, processes and techniques. Experienced TAVR centers have become adept at patient selection and at the procedure itself. The devices also are evolving in ways that should improve outcomes.
First and foremost, centers want positive outcomes. What a good outcome means depends on the patient, though. Very old patients likely value quality of life over longevity. With younger, less sick patients, years gained may matter more, and durability plays an increasingly important role.
Payers are watching TAVR developments closely. TAVR is expensive and if procedures fail to provide value they may balk at footing the bill—especially in cases where surgery might be an option, albeit a more invasive one.
Hospitals might think twice about TAVR if they continue to lose money by offering it, too. Of course, there is a possible coattail effect, and the minimalist approach highlighted in the cover story helps to whittle costs. The devices themselves account for much of the expense, and the anticipated competition between manufacturers may lower prices. Eventually.
Unrelated to TAVR, two articles describe what must have felt like finding a $100 bill in a mothballed winter coat pocket. Lourdes Health System in Camden, N.J., recouped $4.6 million after discovering an accounting error. See page 36 for details. In a guest column, Sheree Schroeder of the Accreditation for Cardiovascular Excellence offers ways to avoid making costly billing mistakes.
If you have similar stories you would like to share, please email me. We welcome the opportunity to pass on tips and good practices.