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Aortic and vascular disease
Original research article
Impact of transcatheter aortic valve implantation on the risk of mortality in patients with severe aortic valve diseases: a health insurance-based analysis
  1. Alexander Barth1,2,
  2. Seyrani Yücel3,
  3. Hüseyin Ince3 and
  4. Gabriele Doblhammer1,2
  1. 1 Institute of Sociology and Demography, University of Rostock, Rostock, Germany
  2. 2 Rostock Center for the Study of Demographic Change, University of Rostock, Rostock, Germany
  3. 3 Divison of Cardiology, University Hospital Rostock, Rostock, Germany
  1. Correspondence to Alexander Barth; alexander.barth2{at}uni-rostock.de

Abstract

Background Transcatheter aortic valve implantation (TAVI) is a minimally invasive treatment for aortic valve patients who are inoperable or have a prohibitively high surgical risk for surgical aortic valve replacement (SAVR). Most studies compare the efficacy of TAVI and SAVR, yet the assessment of TAVI for this group of patients requires more study.

Methods This quasiexperimental study compares TAVI cases (ages of 75–90 years, n=187) ex-post with a control group without implantation (n=728, 4:1 ratio intended). The control group was drawn randomly on the condition that it matches the TAVI cases based on age at aortic valve disease incidence, gender and comorbidity index. The mortality risk is analysed from incident diagnosis. Data were taken from three random samples of health claims data in Germany’s largest public health insurance (Allgemeine Ortskrankenkassen) and cover the years 2004–2013 (n=750 000).

Results Compared with the medically treated control group with 6+ comorbidities, medically treated patients with fewer comorbidities have half the mortality risk (HR 0.48, 95% CI 0.34 to 0.69, p<0.001). TAVI patients with fewer than six comorbidities show a mortality risk half that (HR 0.23, 95% CI 0.09 to 0.63, p=0.004). TAVI patients with 6+ comorbidities do not benefit from TAVI compared with the control group with 6+ comorbidities (HR 0.99, 95% CI 0.71 to 1.36, p=0.93).

Conclusion TAVI is an effective therapy for aortic valve disease patients with few comorbidities; it is not effective for patients with a high comorbidity burden. Careful assessment of the individual patient in terms of comorbidities is important for a beneficial outcome.

  • minimally invasive
  • aortic valve disease
  • quality of care and outcomes

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2017-000756

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    Footnotes

    • Contributors AB carried out the statistical analysis and drafted the manuscript; AB and SY revised the manuscript. AB prepared the data. All authors conceived the study; AB implemented the study. All authors read and approved the final manuscript.

    • Funding This study was funded by Bundesministerium für Bildung und Forschung.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.