TAVR outcomes worse than expected at 11% of US facilities

Transcatheter aortic valve replacement (TAVR) outcomes have been worse than expected for 11% of healthcare providers in the United States, according to a new analysis of data from 2015 to 2017.

The findings were presented Sunday, March 29, at the American College of Cardiology’s Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC). Lead author Nimesh Desai, MD, PhD, associate professor of surgery at the Hospital of the University of Pennsylvania, and colleagues explored outcomes from more than 54,000 patients treated at 301 different facilities. All data came from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (STS/ACC TVT) Registry.

While 80% of providers said their rate of in-hospital complications was as expected, 11% said their complication rates were worse than expected.

“There’s clearly an opportunity to improve processes and try to better standardize care to decrease variation between different sites,” Desai said in a statement. “The overarching goal of this work is to provide transparency to the public and also to provide feedback to sites so that they can review their practices and develop ways to improve the results in their patients.”

The researchers also worked to develop a model that could help patients make TAVR-related decisions, basing it around four outcomes that impact a person’s quality of life: stroke, life-threatening/disabling stroke, stage three acute kidney injury and moderate/severe paravalvular leak. That model was then applied to the STS/ACC TVT Registry to compare the performance of sites throughout the United States.

“We wanted to develop a way of assessing quality using endpoints that are very important to patients,” Desai said. “Among registries for major cardiovascular procedures, this is the first metric to incorporate the patient’s functional status and quality of life, both in the risk assessment of the patient and in the derivation of the outcome measures.”