Incidence,Trends,and Predictors of Palliative Care Consultation After Aortic Valve Replacement in the United States

Abstract

Aim:

Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) have become a reasonably safe procedure with acceptable morbidity and mortality rate. However, little is known regarding the incidence, trends, and predictors of palliative care (PC) consult in aortic valve replacement (AVR) patients. The main purpose of this analysis was to assess the incidence, trends, and predictors of PC consultation in AVR recipients using the Nationwide Inpatient Sample (NIS) database.

Materials and Methods:

We queried the NIS database from 2005 to September 2015 to identify those who underwent TAVR or SAVR and had PC referral during the index hospitalization. Adjusted odds ratio (aOR) was calculated to identify patient demographic, social and hospital characteristics, and procedural characteristics associated with PC consult using multivariable regression analysis. We also reported the trends of PC referral in AVR recipients.

Results:

A total of 522 765 admissions (mean age: 75.3 ± 7.8 years, 40.3% female) who had TAVR (1.7% transapical and 9.2% endovascular approach) and SAVR (89.2%) were identified. Inpatient mortality was 3.96%, and 0.5% patients of the total admissions had PC consultation. The PC referral for SAVR increased from 0.90 to 7.2 per 1000 SAVR from 2005 to 2015 (P = .011), while it remained stable ranging from 9.30 to 13.3 PC consults per 1000 TAVR (P = .86). Age 80 to 89 (aOR: 1.93), age ≥90 years (aOR: 2.57), female sex (aOR: 1.36), electrolyte derangement (aOR: 1.90), weight loss (aOR: 1.88), and do not resuscitate status (aOR: 44.4) were associated with PC consult. West region (aOR: 1.46) and Medicaid (aOR: 3.05) were independently associated with PC consult. Endovascular (aOR: 1.88) and transapical TAVR (aOR: 2.80) had higher PC referral rates compared with SAVR.

Conclusions:

There was an increase in trends for utilization of PC service in SAVR admissions while it remained unchanged in TAVR cohort, but the overall PC referral rate was low in AVR recipients during the index hospitalization.

Keywords

surgical aortic valve replacement transcatheter aortic valve replacement palliative care

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References

Smith

Leon

Mack

; PARTNER Trial Investigators. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364(23):2187–2198.

Minutello

Wong

Swaminathan

. Costs and in-hospital outcomes of transcatheter aortic valve implantation versus surgical aortic valve replacement in commercial cases using a propensity score matched model. Am J Cardiol. 2015;115(10):1443–1447.

Leon

Smith

Mack

; PARTNER 2 Investigators. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374(17):1609–1620.

Reardon

Van Mieghem

Popma

; SURTAVI Investigators. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2017;376(14):1321–1331.

Beernaert

Cohen

Deliens

. Referral to palliative care in COPD and other chronic diseases: a population-based study. Respir Med. 2013;107(11):1731–1739.

Sidebottom

Jorgenson

Richards

Kirven

Sillah

. Inpatient palliative care for patients with acute heart failure: outcomes from a randomized trial. J Palliat Med. 2015;18(2):134–142.

Rush

Walley

Celi

Rajoriya

Brahmania

. Palliative care access for hospitalized patients with end-stage liver disease across the United States. Hepatology. 2017;66(5):1585–1591.

Smith

Rhodes

Xuan

Halm

. Predictors of placement of inpatient palliative care consult orders among patients with breast, lung, and colon cancer in a safety net hospital system. Am J Hosp Palliat Care. 2018:35(4):586–591.

Cheang

Rose

Cheung

Thomas

. Current challenges in palliative care provision for heart failure in the UK: a survey on the perspectives of palliative care professionals. Open Heart. 2015;2(1):e000188.

10.

Kappetein

Head

Généreux

. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J Am Coll Cardiol. 2012;60(15):1438–1454.

11.

Overview of the National (Nationwide) Inpatient Sample. HCUP Databases. Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality, Rockville, MD. 2018. www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed March 15, 2018.

12.

Elixhauser

Steiner

Harris

Coffey

. Comorbidity measures for use with administrative data. Med Care. 1998;36(1):8–27.

13.

Quan

Sundararajan

Halfon

. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43(11):1130–1139.

14.

Feder

Redeker

Jeon

. Validation of the ICD-9 diagnostic code for palliative care in patients hospitalized with heart failure within the Veterans health administration. Am J Hosp Palliat Care. 2018;35(7):959–965.

15.

Method Series Report 2015-09. Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality, Rockville, MD [Internet]. 2018. www.hcup-us.ahrq.gov/reports/methods/2015_09.jsp Accessed March 15, 2018.

16.

Khera

Angraal

Couch

. Adherence to methodological standards in research using the national inpatient sample. JAMA. 2017;318(20):2011–2018.

17.

Grover

Vemulapalli

Carroll

; STS/ACC TVT Registry. 2016 Annual Report of the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. J Am Coll Cardiol. 2017;69(10):1215–1230.

18.

D’Agostino

Jacobs

Badhwar

. The Society of Thoracic Surgeons adult cardiac surgery database: 2018 update on outcomes and quality. Ann Thorac Surg. 2018;105(1):15–23.

19.

Mosenthal

Weissman

Curtis

. Integrating palliative care in the surgical and trauma intensive care unit: a report from the Improving Palliative Care in the Intensive Care Unit (IPAL-ICU) Project Advisory Board and the Center to Advance Palliative Care. Crit Care Med. 2012;40(4):1199–1206.

20.

Hua

Blinderman

Wunsch

. Estimates of the need for palliative care consultation across united states intensive care units using a trigger-based model. Am J Respir Crit Care Med. 2014;189(4):428–436.

21.

Finkelstein

Goldstein

Horton

Eshak

Lee

Kohli-Seth

. Developing triggers for the surgical intensive care unit for palliative care integration. J Crit Care. 2016;35:7–11.

22.

Chatterjee

Goyal

Kakkera

Harrington

Corwin

. National Trends (2009-2013) for palliative care utilization for patients receiving prolonged mechanical ventilation. Crit Care Med. 2018;46(8):1230–1237.

23.

Sheckter

Hung

Rochlin

Maan

Karanas

Curtin

. Trends and inpatient outcomes for palliative care services in major burn patients: a 10-year analysis of the nationwide inpatient sample. Burns. 2018;44(8):1903–1909.

24.

Patel

Secheresiu

Shah

. Trends and predictors of palliative care referrals in patients with acute heart failure. Am J Hosp Palliat Care. 2019;36(2):147–153.

25.

America’s Care of Serious Illness: 2015 State-by-state report card on access to palliative care in our nation’s hospitals. Center to Advance Palliative Care Web site. https://reportcard.capc.org. Accessed January 12, 2018.

26.

Ando

Takagi

Grines

. Transfemoral, transapical and transcatheter aortic valve implantation and surgical aortic valve replacement: a meta-analysis of direct and adjusted indirect comparisons of early and mid-term deaths. Interact Cardiovasc Thorac Surg. 2017;25(3):484–492.

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