title: Regional variation in prosthesis choice for aortic valve replacement in older patients.
abstract: OBJECTIVE
  The study aim was to investigate regional practice patterns regarding aortic valve replacement (AVR) by comparing bioprosthetic versus mechanical valve usage in patients aged > or = 65 years, and to determine whether the choice of valve type for AVR in these patients varied by geographic region.
  
  
  METHODS
  The details were acquired of all mechanical and bioprosthetic AVRs performed in patients aged > or = 65 years between 1999 and 2006, as contained in the Florida State Inpatient Database. By using a small area analysis, the patients' zip codes were aggregated into hospital referral regions based on where they were most likely to receive AVR. The regional rates of both mechanical and bioprosthetic AVR were then determined.
  
  
  RESULTS
  Of 23,925 AVRs performed during this period, 15,368 involved a bioprosthetic aortic valve and 8,557 a mechanical aortic valve. Statewide, 64% of AVRs in these patients involved a bioprosthesis. Regional rates of mechanical AVRs varied widely, from 10% to 81%.
  
  
  CONCLUSIONS
  Substantial regional differences were identified in practice patterns for AVR in patients aged > or = 65 years. This suggested that provider preference, in addition to patient pathology, would often determine the type of valve implanted.
authors.affiliation: Jefferson Medical College, Philadelphia, PA, USA.
authors.forename: Eric I
authors.initials: EI
authors.lastname: Ehieli
authors.forename: Tara
authors.initials: T
authors.lastname: Karamlou
authors.forename: Brian S
authors.initials: BS
authors.lastname: Diggs
authors.forename: Wendy L
authors.initials: WL
authors.lastname: Walker
authors.forename: Kirk A
authors.initials: KA
authors.lastname: Caddell
authors.forename: J S
authors.initials: JS
authors.lastname: de la Cruz
authors.forename: Karl F
authors.initials: KF
authors.lastname: Welke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D001705:Bioprosthesis / Q000009:adverse effects*; D002114:Calcinosis / Q000209:etiology; D002755:Choice Behavior; D005260:Female; D005431:Florida / Q000453:epidemiology; D006299:Health Services for the Aged / Q000592:standards / Q000706:statistics & numerical data; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000009:adverse effects / Q000592:standards / Q000706:statistics & numerical data; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D008017:Life Expectancy; D008297:Male; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012086:Reoperation / Q000706:statistics & numerical data; D020379:Risk Adjustment
chemical_list: D000925:Anticoagulants