Trends in aortic valve replacement for elderly patients in the United States, 1999-2011
There is a need to describe contemporary outcomes of surgical aortic valve replacement (AVR) as the population ages and transcatheter options emerge. To assess procedure rates and outcomes of surgical AVR over time. A serial cross-sectional cohort study of 82,755,924 Medicare fee-for-service benefic...
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| Vydáno v: | JAMA : the journal of the American Medical Association Ročník 310; číslo 19; s. 2078 |
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| Médium: | Journal Article |
| Jazyk: | angličtina |
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United States
20.11.2013
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| ISSN: | 1538-3598, 1538-3598 |
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| Abstract | There is a need to describe contemporary outcomes of surgical aortic valve replacement (AVR) as the population ages and transcatheter options emerge.
To assess procedure rates and outcomes of surgical AVR over time.
A serial cross-sectional cohort study of 82,755,924 Medicare fee-for-service beneficiaries undergoing AVR in the United States between 1999 and 2011.
Procedure rates for surgical AVR alone and with coronary artery bypass graft (CABG) surgery, 30-day and 1-year mortality, and 30-day readmission rates.
The AVR procedure rate increased by 19 (95% CI, 19-20) procedures per 100,000 person-years over the 12-year period (P<.001), with an age-, sex-, and race-adjusted rate increase of 1.6% (95% CI, 1.0%-1.8%) per year. Mortality decreased at 30 days (absolute decrease, 3.4%; 95% CI, 3.0%-3.8%; adjusted annual decrease, 4.1%; 95% CI, 3.7%- 4.4%) per year and at 1 year (absolute decrease, 2.6%; 95% CI, 2.1%-3.2%; adjusted annual decrease, 2.5%; 95% CI, 2.3%-2.8%). Thirty-day all-cause readmission also decreased by 1.1% (95% CI, 0.9%-1.3%) per year. Aortic valve replacement with CABG surgery decreased, women and black patients had lower procedure and higher mortality rates, and mechanical prosethetic implants decreased, but 23.9% of patients 85 years and older continued to receive a mechanical prosthesis in 2011.
Between 1999 and 2011, the rate of surgical AVR for elderly patients in the United States increased and outcomes improved substantially. Medicare data preclude the identification of the causes of the findings and the trends in procedure rates and outcomes cannot be causally linked. Nevertheless, the findings may be a useful benchmark for outcomes with surgical AVR for older patients eligible for surgery considering newer transcatheter treatments. |
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| AbstractList | There is a need to describe contemporary outcomes of surgical aortic valve replacement (AVR) as the population ages and transcatheter options emerge.
To assess procedure rates and outcomes of surgical AVR over time.
A serial cross-sectional cohort study of 82,755,924 Medicare fee-for-service beneficiaries undergoing AVR in the United States between 1999 and 2011.
Procedure rates for surgical AVR alone and with coronary artery bypass graft (CABG) surgery, 30-day and 1-year mortality, and 30-day readmission rates.
The AVR procedure rate increased by 19 (95% CI, 19-20) procedures per 100,000 person-years over the 12-year period (P<.001), with an age-, sex-, and race-adjusted rate increase of 1.6% (95% CI, 1.0%-1.8%) per year. Mortality decreased at 30 days (absolute decrease, 3.4%; 95% CI, 3.0%-3.8%; adjusted annual decrease, 4.1%; 95% CI, 3.7%- 4.4%) per year and at 1 year (absolute decrease, 2.6%; 95% CI, 2.1%-3.2%; adjusted annual decrease, 2.5%; 95% CI, 2.3%-2.8%). Thirty-day all-cause readmission also decreased by 1.1% (95% CI, 0.9%-1.3%) per year. Aortic valve replacement with CABG surgery decreased, women and black patients had lower procedure and higher mortality rates, and mechanical prosethetic implants decreased, but 23.9% of patients 85 years and older continued to receive a mechanical prosthesis in 2011.
Between 1999 and 2011, the rate of surgical AVR for elderly patients in the United States increased and outcomes improved substantially. Medicare data preclude the identification of the causes of the findings and the trends in procedure rates and outcomes cannot be causally linked. Nevertheless, the findings may be a useful benchmark for outcomes with surgical AVR for older patients eligible for surgery considering newer transcatheter treatments. There is a need to describe contemporary outcomes of surgical aortic valve replacement (AVR) as the population ages and transcatheter options emerge.IMPORTANCEThere is a need to describe contemporary outcomes of surgical aortic valve replacement (AVR) as the population ages and transcatheter options emerge.To assess procedure rates and outcomes of surgical AVR over time.OBJECTIVETo assess procedure rates and outcomes of surgical AVR over time.A serial cross-sectional cohort study of 82,755,924 Medicare fee-for-service beneficiaries undergoing AVR in the United States between 1999 and 2011.DESIGN, SETTING, AND PARTICIPANTSA serial cross-sectional cohort study of 82,755,924 Medicare fee-for-service beneficiaries undergoing AVR in the United States between 1999 and 2011.Procedure rates for surgical AVR alone and with coronary artery bypass graft (CABG) surgery, 30-day and 1-year mortality, and 30-day readmission rates.MAIN OUTCOMES AND MEASURESProcedure rates for surgical AVR alone and with coronary artery bypass graft (CABG) surgery, 30-day and 1-year mortality, and 30-day readmission rates.The AVR procedure rate increased by 19 (95% CI, 19-20) procedures per 100,000 person-years over the 12-year period (P<.001), with an age-, sex-, and race-adjusted rate increase of 1.6% (95% CI, 1.0%-1.8%) per year. Mortality decreased at 30 days (absolute decrease, 3.4%; 95% CI, 3.0%-3.8%; adjusted annual decrease, 4.1%; 95% CI, 3.7%- 4.4%) per year and at 1 year (absolute decrease, 2.6%; 95% CI, 2.1%-3.2%; adjusted annual decrease, 2.5%; 95% CI, 2.3%-2.8%). Thirty-day all-cause readmission also decreased by 1.1% (95% CI, 0.9%-1.3%) per year. Aortic valve replacement with CABG surgery decreased, women and black patients had lower procedure and higher mortality rates, and mechanical prosethetic implants decreased, but 23.9% of patients 85 years and older continued to receive a mechanical prosthesis in 2011.RESULTSThe AVR procedure rate increased by 19 (95% CI, 19-20) procedures per 100,000 person-years over the 12-year period (P<.001), with an age-, sex-, and race-adjusted rate increase of 1.6% (95% CI, 1.0%-1.8%) per year. Mortality decreased at 30 days (absolute decrease, 3.4%; 95% CI, 3.0%-3.8%; adjusted annual decrease, 4.1%; 95% CI, 3.7%- 4.4%) per year and at 1 year (absolute decrease, 2.6%; 95% CI, 2.1%-3.2%; adjusted annual decrease, 2.5%; 95% CI, 2.3%-2.8%). Thirty-day all-cause readmission also decreased by 1.1% (95% CI, 0.9%-1.3%) per year. Aortic valve replacement with CABG surgery decreased, women and black patients had lower procedure and higher mortality rates, and mechanical prosethetic implants decreased, but 23.9% of patients 85 years and older continued to receive a mechanical prosthesis in 2011.Between 1999 and 2011, the rate of surgical AVR for elderly patients in the United States increased and outcomes improved substantially. Medicare data preclude the identification of the causes of the findings and the trends in procedure rates and outcomes cannot be causally linked. Nevertheless, the findings may be a useful benchmark for outcomes with surgical AVR for older patients eligible for surgery considering newer transcatheter treatments.CONCLUSIONS AND RELEVANCEBetween 1999 and 2011, the rate of surgical AVR for elderly patients in the United States increased and outcomes improved substantially. Medicare data preclude the identification of the causes of the findings and the trends in procedure rates and outcomes cannot be causally linked. Nevertheless, the findings may be a useful benchmark for outcomes with surgical AVR for older patients eligible for surgery considering newer transcatheter treatments. |
| Author | Sugeng, Lissa Dodson, John A Krumholz, Harlan M Barreto-Filho, José Augusto Geirsson, Arnar Wang, Yun Desai, Mayur M |
| Author_xml | – sequence: 1 givenname: José Augusto surname: Barreto-Filho fullname: Barreto-Filho, José Augusto organization: Division of Cardiology, Federal University of Sergipe, and the Clínica e Hospital São Lucas, Aracaju, Sergipe, Brazil10Center for Outcomes Research and Evaluation at Yale-New Haven Hospital (during the time that the work was conducted) – sequence: 2 givenname: Yun surname: Wang fullname: Wang, Yun – sequence: 3 givenname: John A surname: Dodson fullname: Dodson, John A – sequence: 4 givenname: Mayur M surname: Desai fullname: Desai, Mayur M – sequence: 5 givenname: Lissa surname: Sugeng fullname: Sugeng, Lissa – sequence: 6 givenname: Arnar surname: Geirsson fullname: Geirsson, Arnar – sequence: 7 givenname: Harlan M surname: Krumholz fullname: Krumholz, Harlan M |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/24240935$$D View this record in MEDLINE/PubMed |
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| Snippet | There is a need to describe contemporary outcomes of surgical aortic valve replacement (AVR) as the population ages and transcatheter options emerge.
To assess... There is a need to describe contemporary outcomes of surgical aortic valve replacement (AVR) as the population ages and transcatheter options... |
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| SubjectTerms | Age Factors Aged Aged, 80 and over Aortic Valve - surgery Bicuspid Aortic Valve Disease Black or African American Black People - statistics & numerical data Cohort Studies Coronary Artery Bypass - mortality Coronary Artery Bypass - statistics & numerical data Cross-Sectional Studies Fee-for-Service Plans - statistics & numerical data Female Heart Defects, Congenital - surgery Heart Valve Diseases - surgery Heart Valve Prosthesis Heart Valve Prosthesis Implantation - instrumentation Heart Valve Prosthesis Implantation - mortality Heart Valve Prosthesis Implantation - statistics & numerical data Humans Length of Stay - statistics & numerical data Male Medicare - statistics & numerical data Patient Readmission - statistics & numerical data Treatment Outcome United States - epidemiology |
| Title | Trends in aortic valve replacement for elderly patients in the United States, 1999-2011 |
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