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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Temporal Trends and Clinical Outcomes of Transcatheter Aortic Valve Replacement in Nonagenarians
Journal of the American Heart Association, Volume 8, No. 21, Article e013685, Year 2019
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Description
Background: Contemporary outcomes of transcatheter aortic valve replacement (TAVR) in nonagenarians are unknown. Methods and Results: We identified 13 544 nonagenarians (aged 90–100 years) who underwent TAVR between 2012 and 2016 using Medicare claims. Generalized estimating equations were used to study the change in short-term outcomes among nonagenarians over time. We compared outcomes between nonagenarians and non-nonagenarians undergoing TAVR in 2016. A mixed-effect multivariable logistic regression was performed to determine predictors of 30-day mortality in nonagenarians in 2016. A center was defined as a high-volume center if it performed ≥100 TAVR procedures per year. After adjusting for changes in patients’ characteristics, risk-adjusted 30-day mortality declined in nonagenarians from 9.8% in 2012 to 4.4% in 2016 (P<0.001), whereas mortality for patients <90 years decreased from 6.4% to 3.5%. In 2016, 35 712 TAVR procedures were performed, of which 12.7% were in nonagenarians. Overall, in-hospital mortality in 2016 was higher in nonagenarians compared with younger patients (2.4% versus 1.7%, P<0.05) but did not differ in analysis limited to high-volume centers (2.2% versus 1.7%; odds ratio: 1.33; 95% CI, 0.97–1.81; P=0.07). Important predictors of 30-day mortality in nonagenarians included in-hospital stroke (adjusted odds ratio [aOR]: 8.67; 95% CI, 5.03–15.00), acute kidney injury (aOR: 4.11; 95% CI, 2.90–5.83), blood transfusion (aOR: 2.66; 95% CI, 1.81–3.90), respiratory complications (aOR: 2.96; 95% CI, 1.52–5.76), heart failure (aOR: 1.86; 95% CI, 1.04–3.34), coagulopathy (aOR: 1.59; 95% CI, 1.12–2.26; P<0.05 for all). Conclusions: Short-term outcomes after TAVR have improved in nonagenarians. Several procedural complications were associated with increased 30-day mortality among nonagenarians. © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
Authors & Co-Authors
Mentias, Amgad
United States, Iowa City
University of Iowa Carver College of Medicine
Saad, Marwan
United States, Providence
Brown University
Desai, Milind Y.
United States, Cleveland
Cleveland Clinic Foundation
Horwitz, Phillip A.
United States, Iowa City
University of Iowa Carver College of Medicine
Rossen, James D.
United States, Iowa City
University of Iowa Carver College of Medicine
Panaich, Sidakpal S.
United States, Iowa City
University of Iowa Carver College of Medicine
Elbadawi, Ayman
United States, Galveston
The University of Texas Medical Branch at Galveston
Qazi, Abdul Haseeb
United States, Iowa City
University of Iowa Carver College of Medicine
Sorajja, Paul
United States, Minneapolis
Abbott Northwestern Hospital
Jneid, Hani M.
United States, Houston
Baylor College of Medicine
Kapadia, Samir R.
United States, Cleveland
Cleveland Clinic Foundation
London, Barry
United States, Iowa City
University of Iowa Carver College of Medicine
Vaughan-Sarrazin, Mary S.
United States, Iowa City
University of Iowa Carver College of Medicine
United States
Va Medical Center
Statistics
Citations: 16
Authors: 13
Affiliations: 7
Identifiers
Doi:
10.1161/JAHA.119.013685
ISSN:
20479980
Research Areas
Health System And Policy
Noncommunicable Diseases
Violence And Injury
Study Design
Case-Control Study