Trends in Utilization and Outcomes of Urgent/Emergent versus Elective TAVR Between 2012-2015

Background:
There is limited data on time trends of utilization and outcomes of urgent/emergent and elective transcatheter aortic valve replacement (TAVR) performed in the United States.

Methods:
Patients who underwent TAVR were identified in the Nationwide Inpatient Sample (NIS) database (2012-2015). Urgent/Emergent (during same hospitalization for acute decompensated heart failure, acute myocardial infarction, cardiogenic shock, unstable angina) and Elective TAVRs were defined in accordance with TVT definitions. Then, time trends of adjusted in-hospital mortality, length of stay (LOS) and other secondary outcomes was analyzed using complex samples regression.

Results:
We identified a total of 39,700 TAVR procedures between 2012-2015, of which 3,930 cases were urgent/emergent, while 35,770 were elective TAVR. Over the study period, there was increase in performance of both urgent/emergent (500 to 1,265) and elective (4,560 to 11,555) TAVRs. In elective TAVR, there was significant decrease in risk of in-hospital mortality [OR 0.84 (0.73-0.94); p<0.001] and length of stay [0.90 (0.88-0.92); p<0.001] between 2012-2015. In the urgent/emergent TAVR arm, there were no significant differences in in-hospital mortality [OR 0.93 (0.63-1.3); p=0.708] and LOS [1.007 (0.96-1.1); p=0.78]. Similarly, there was significant decline in risk of acute kidney injury, major bleeding and vascular complications in the elective group, but not in urgent/emergent TAVR.

Conclusions:
In hospital mortality and LOS have decreased over time for patients undergoing elective TAVR. Future studies should identify factors aimed at improving outcomes of patients undergoing urgent/emergent TAVR.