背景:住院治疗是患者和社会的主要负担,但可能是可以预防的。我们检查了接受经导管主动脉瓣置换术(TAVR)的患者的一年住院负担,并比较了接受孤立性外科主动脉瓣置换术(SAVR)的患者的住院率和住院方式。
方法:使用丹麦全国注册,我们确定了首次接受TAVR和孤立SAVR(2008-2019)的患者,分别。根据出院诊断代码,随后的住院分为心血管或非心血管。
结果:接受TAVR(N=4,921)的患者比接受SAVR(N=5,220)的患者年龄更大,合并症更多。在出院后的第一年内,TAVR和SAVR组分别有5,725和4,426例住院,分别。在TAVR后的一年随访期间,46.6%没有被录取,25.4%被录取过一次,12.6%的两倍,和15.4%的三倍或更多。接受SAVR的患者的相应比例为55.3%,25.1%,10.0%,和9.5%,分别。在TAVR后住院≥1次的患者中,50.3%的人住院总长在1-7天之间,19.0%8-14天,18.0%15-30天,9.9%31-60天,2.8%≥61天。接受SAVR的患者的相应比例为58.6%,17.2%,13.1%,7.4%,和3.7%,分别。与接受SAVR的患者相比,接受TAVR的患者早期较低(第0-30天:HR0.89[95CI,0.80-0.98]),但晚期住院率较高(第31-365天:1.46[1.32-1.60])。
结论:TAVR后一年的住院负担是巨大的。与接受孤立SAVR的患者相比,那些接受TAVR的人早期有一个较低的,但更高的延迟住院率-这种差异可能反映了患者队列中无法测量的差异。
BACKGROUND: Hospitalizations are a major burden for both patients and society but are potentially preventable. We examined the one-year hospitalization burden in patients undergoing transcatheter aortic valve replacement (TAVR) and compared hospitalization rates and patterns with those undergoing isolated surgical aortic valve replacement (SAVR).
METHODS: Using Danish nationwide registries, we identified patients who underwent first-time TAVR and isolated SAVR (2008-2019), respectively. Subsequent hospitalizations were classified as cardiovascular or noncardiovascular according to discharge diagnosis codes.
RESULTS: Patients undergoing TAVR (N = 4,921) were older and had more comorbidities than those undergoing SAVR (N = 5,220). There were 5,725 and 4,426 hospitalizations within the first year after discharge in the TAVR and SAVR group, respectively. During the one-year follow-up period post-TAVR, 46.6% were not admitted, 25.4% were admitted once, 12.6% twice, and 15.4% 3 times or more. The corresponding proportions in patients undergoing SAVR were 55.3%, 25.1%, 10.0%, and 9.5%, respectively. Among patients with ≥1 hospitalization following TAVR, 50.3% had a total length of all hospital stays between 1 and 7days, 19.0% 8-14days, 18.0% 15-30days, 9.9% 31-60days, and 2.8% ≥61days. The corresponding proportions for patients undergoing SAVR were 58.6%, 17.2%, 13.1%, 7.4%, and 3.7%, respectively. Compared with patients undergoing SAVR, those undergoing TAVR had a lower early (day0-30: HR 0.89 [95% CI, 0.80-0.98]), but a higher late hospitalization rate (day 31-365: 1.46 [1.32-1.60]).
CONCLUSIONS: The 1-year hospitalization burden following TAVR is substantial. Compared with patients undergoing isolated SAVR, those undergoing TAVR had a lower early, but a higher late hospitalization rate - a difference that likely reflects unmeasured differences in the patient cohorts.