Health Care Resource, Economic, and Readmission Implications After Acute Decompensated Aortic Stenosis–A Nationwide Study
(2023) In American Journal of Cardiology 204. p.200-206- Abstract
Acute decompensated aortic stenosis (ADAS) is common. The cumulative burden of ADAS from a clinical, health care resource, and financial perspective is unknown. This study sought to assess the national impact of ADAS compared with electively treated, stable patients with aortic stenosis (non-ADAS). Using the National Readmissions Database between 2016 and 2019, patients with ADAS and non-ADAS were identified using International Classification of Diseases, Tenth Revision codes. Patients with ADAS were propensity-matched to non-ADAS patients (1:2) using age, gender, and Charlson co-morbidity index. We compared in-hospital mortality, length of stay (LOS), health care–associated costs, and 90-day readmission data between the 2 cohorts. A... (More)
Acute decompensated aortic stenosis (ADAS) is common. The cumulative burden of ADAS from a clinical, health care resource, and financial perspective is unknown. This study sought to assess the national impact of ADAS compared with electively treated, stable patients with aortic stenosis (non-ADAS). Using the National Readmissions Database between 2016 and 2019, patients with ADAS and non-ADAS were identified using International Classification of Diseases, Tenth Revision codes. Patients with ADAS were propensity-matched to non-ADAS patients (1:2) using age, gender, and Charlson co-morbidity index. We compared in-hospital mortality, length of stay (LOS), health care–associated costs, and 90-day readmission data between the 2 cohorts. A total of 51,498 propensity-matched patients were included in this study: median age 75 years, 64% men. The in-hospital mortality for ADAS was higher than non-ADAS (2.8% vs 1.5%, p <0.0001). The LOS during the index admission was longer for ADAS (9 [5 to 13] vs 4 [2 to 6] days, p <0.0001). The health care–associated costs per patient was greater for ADAS ($55,450.0 [41,860.4 to 74,500.7] vs $43,405.7 [34,218.5 to 56,034.8], p <0.0001). Readmission to hospital within 90 days was more frequent in ADAS (21.1 vs 16.8%, p <0.001). The in-hospital mortality during readmission was higher with ADAS (3.9% vs 2.8%, p = 0.004). The readmission LOS was longer with ADAS (4 [2 to 7] vs 3 [2 to 6] days, p <0.0001). In conclusion, ADAS imposes a significant burden clinically and financially and on health care resources compared with non-ADAS during the index admission and 90-day follow-up. There is an urgent need to predict ADAS and optimize the timing of aortic valve replacement to reduce the incidence and the burden associated with ADAS.
(Less)
- author
- Patel, Kush P. ; Sawatari, Hiroyuki ; Chahal, Anwar ; Vuyisile, Nkomo T. ; Somers, Virend ; Mullen, Michael J. ; Ricci, Fabrizio LU and Khanji, Mohammed Y.
- organization
- publishing date
- 2023-10-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- acute decompensated aortic stenosis, acute heart failure, aortic stenosis, surgical aortic valve replacement, TAVI, transcatheter aortic valve replacement
- in
- American Journal of Cardiology
- volume
- 204
- pages
- 7 pages
- publisher
- Excerpta Medica
- external identifiers
-
- scopus:85166977326
- pmid:37544145
- ISSN
- 0002-9149
- DOI
- 10.1016/j.amjcard.2023.07.081
- language
- English
- LU publication?
- yes
- id
- b52338a0-c3c4-4bb7-a8f0-0ed71cc3c9a0
- date added to LUP
- 2023-10-24 13:30:21
- date last changed
- 2024-06-15 10:41:52
@article{b52338a0-c3c4-4bb7-a8f0-0ed71cc3c9a0,
abstract = {{<p>Acute decompensated aortic stenosis (ADAS) is common. The cumulative burden of ADAS from a clinical, health care resource, and financial perspective is unknown. This study sought to assess the national impact of ADAS compared with electively treated, stable patients with aortic stenosis (non-ADAS). Using the National Readmissions Database between 2016 and 2019, patients with ADAS and non-ADAS were identified using International Classification of Diseases, Tenth Revision codes. Patients with ADAS were propensity-matched to non-ADAS patients (1:2) using age, gender, and Charlson co-morbidity index. We compared in-hospital mortality, length of stay (LOS), health care–associated costs, and 90-day readmission data between the 2 cohorts. A total of 51,498 propensity-matched patients were included in this study: median age 75 years, 64% men. The in-hospital mortality for ADAS was higher than non-ADAS (2.8% vs 1.5%, p <0.0001). The LOS during the index admission was longer for ADAS (9 [5 to 13] vs 4 [2 to 6] days, p <0.0001). The health care–associated costs per patient was greater for ADAS ($55,450.0 [41,860.4 to 74,500.7] vs $43,405.7 [34,218.5 to 56,034.8], p <0.0001). Readmission to hospital within 90 days was more frequent in ADAS (21.1 vs 16.8%, p <0.001). The in-hospital mortality during readmission was higher with ADAS (3.9% vs 2.8%, p = 0.004). The readmission LOS was longer with ADAS (4 [2 to 7] vs 3 [2 to 6] days, p <0.0001). In conclusion, ADAS imposes a significant burden clinically and financially and on health care resources compared with non-ADAS during the index admission and 90-day follow-up. There is an urgent need to predict ADAS and optimize the timing of aortic valve replacement to reduce the incidence and the burden associated with ADAS.</p>}},
author = {{Patel, Kush P. and Sawatari, Hiroyuki and Chahal, Anwar and Vuyisile, Nkomo T. and Somers, Virend and Mullen, Michael J. and Ricci, Fabrizio and Khanji, Mohammed Y.}},
issn = {{0002-9149}},
keywords = {{acute decompensated aortic stenosis; acute heart failure; aortic stenosis; surgical aortic valve replacement; TAVI; transcatheter aortic valve replacement}},
language = {{eng}},
month = {{10}},
pages = {{200--206}},
publisher = {{Excerpta Medica}},
series = {{American Journal of Cardiology}},
title = {{Health Care Resource, Economic, and Readmission Implications After Acute Decompensated Aortic Stenosis–A Nationwide Study}},
url = {{http://dx.doi.org/10.1016/j.amjcard.2023.07.081}},
doi = {{10.1016/j.amjcard.2023.07.081}},
volume = {{204}},
year = {{2023}},
}