title: Echocardiographic score as a predictor of in-hospital cost in patients undergoing percutaneous balloon mitral valvuloplasty.
abstract: Percutaneous balloon mitral valvuloplasty (PBMV) is an effective means of palliating mitral stenosis, but it sometimes leads to adverse clinical outcomes and exorbitant in-hospital costs. Because echocardiographic score is known to be predictive of clinical outcome in patients undergoing PBMV, we examined whether it could also be used to predict in-hospital cost. Preprocedure echocardiographic scores, baseline clinical characteristics, and total in-hospital costs were examined among 45 patients who underwent PBMV between January 1, 1992, and January 1, 1994. Patients ranged in age from 18 to 71 years and had preprocedure echocardiographic scores that ranged from 4 to 12. Following PBMV, mean mitral valve area increased from 1.1 +/- 0.3 to 2.4 +/- 0.6 cm2 (p = 0.0001), and mean pressure gradient decreased from 18.3 +/- 5.9 to 6.7 +/- 2.7 mm Hg (p = 0.0001). In-hospital cost for the 45 patients ranged from $3,591 to $70,975 (mean $9,417; median $5,311). Univariate and multiple linear regression analyses demonstrated that among the variables examined, echocardiographic score (p = 0.0007), age (p = 0.01), and preprocedure mitral valve gradient (p = 0.03) were associated with in-hospital cost. Regression modeling suggested that every increase in preprocedure echocardiographic score of one grade was associated with an increase in in-hospital cost of $2,663. Because echocardiographic score is predictive of both clinical outcome and in-hospital cost, we conclude that patients with elevated scores should be considered for alternative therapy.
authors.affiliation: Department of Cardiology, Cleveland Clinic Foundation, Ohio, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Eisenberg
authors.forename: R
authors.initials: R
authors.lastname: Ballal
authors.forename: P A
authors.initials: PA
authors.lastname: Heidenreich
authors.forename: K J
authors.initials: KJ
authors.lastname: Brown
authors.forename: B P
authors.initials: BP
authors.lastname: Griffin
authors.forename: P N
authors.initials: PN
authors.lastname: Casale
authors.forename: E M
authors.initials: EM
authors.lastname: Tuzcu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002404:Catheterization / Q000009:adverse effects*; D003363:Cost Control; D004452:Echocardiography; D005260:Female; D017048:Health Care Costs; D006331:Heart Diseases / Q000191:economics / Q000209:etiology; D006760:Hospitalization / Q000191:economics; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000191:economics* / Q000628:therapy; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D013514:Surgical Procedures, Operative / Q000191:economics