There are "substantial variations" in the quality of TAVR care delivered at the site level in the U.S., with about 11% of sites providing below-average care, according to a study published May 5 in Circulation.

In a retrospective cohort study, Nimesh D. Desai, MD, PhD, et al., looked at data from the STS/ACC TVT Registry to determine if site-level disparity in TAVR outcomes exists in the U.S. The researchers evaluated a cohort of 52,561 TAVR patients between Jan. 1, 2015, and Dec. 31, 2017, and used a novel ranked composite performance measure that considered two main factors: mortality and severe complications. After one year, the rank order of the complications was adjusted based on the correlation between the variable and the study's overall health outcomes. The risk-adjusted outcomes were determined with a 95% probability interval. The researchers found four periprocedural complications to include in the composite risk model: life-threatening or disabling bleeding; stroke; moderate or severe peri-valvular regurgitation; and stage III acute kidney injury.

Results showed that out of the 301 sites in the study, 8% maintained better than expected site performance, 80% performed as expected, and 11% displayed worse than expected performance. In sites with worse than expected performance rates, patients experienced a higher likelihood of stroke, life-threatening or disabling bleeding, 30-day mortality, and moderate or severe peri-valvular leak.

"Using a novel measure based on ranked 30-day outcomes, we have identified significant hospital-level variation in mortality and major complications after TAVR procedures in the [U.S.]," the authors conclude. "Further study is necessary to determine the impact of these measures on TAVR outcomes and structural, process-related, and technical factors associated with high and low-performing sites."

They add that the novel ranked composite performance measure "is scheduled to be publicly reported beginning in mid-2021 as part of ongoing STS/ACC TVT Registry quality improvement initiatives."

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Cardiac Surgery and VHD, Interventions and Structural Heart Disease

Keywords: Transcatheter Aortic Valve Replacement, Quality Improvement, Heart Valve Diseases, Registries, Stroke, Acute Kidney Injury, Hospitals, National Cardiovascular Data Registries, STS/ACC TVT Registry

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