Variation in Hospital Risk-Adjusted Mortality Rates Following Transcatheter Aortic Valve Replacement in the United States: A Report From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry.
The use of transcatheter aortic valve replacement (TAVR) to treat aortic stenosis in the United States is growing, yet little is known about the variation in procedural outcomes in community practice. We developed a TAVR in-hospital mortality risk model and used it to quantify variation in mortality rates across United States (US) TAVR centers.



We analyzed data from 22 248 TAVR procedures performed at 318 sites participating in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry (November 2011 to October 2014). A Bayesian hierarchical model was developed to estimate hospital-specific risk-adjusted mortality rates adjusting for 40 patient baseline factors. A total of 1130 in-hospital deaths (5.1%) were observed. Reliability-adjusted risk-adjusted mortality rate estimates ranged from 3.4% to 7.7% with an interquartile range of 4.8% to 5.4%. A patient's predicted odds of dying was 80% higher if treated by a hospital 1 standard deviation above the mean compared with a hospital 1 standard deviation below the mean (odds ratio =1.8; 95% credible interval, 1.4%-2.2%).



Risk modeling of TAVR in-hospital mortality revealed variation in risk-adjusted mortality rates during the US early commercial experience. Transcatheter Valve Therapy Registry analyses using this model will support research, feedback reporting, and the identification of factors associated with quality.
From the Duke University Medical Center, Durham, NC (S.M.O., J.M.B., D.D., E.D.P.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Denver VA Medical Center, CO (J.S.R.); Massachusetts General Hospital, Boston (D.M.S.); Mayo Clinic, Rochester, MN (D.R.H.); Centers for Medicare & Medicaid Services, Baltimore, MD (R.B.H.); Emory University School of Medicine, Atlanta, GA (V.H.T.); and University of Florida, Jacksonville (F.H.E.). sean.m.obrien@duke.edu.
Sean M
SM
O'Brien
From the Duke University Medical Center, Durham, NC (S.M.O., J.M.B., D.D., E.D.P.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Denver VA Medical Center, CO (J.S.R.); Massachusetts General Hospital, Boston (D.M.S.); Mayo Clinic, Rochester, MN (D.R.H.); Centers for Medicare & Medicaid Services, Baltimore, MD (R.B.H.); Emory University School of Medicine, Atlanta, GA (V.H.T.); and University of Florida, Jacksonville (F.H.E.).
David J
DJ
Cohen
From the Duke University Medical Center, Durham, NC (S.M.O., J.M.B., D.D., E.D.P.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Denver VA Medical Center, CO (J.S.R.); Massachusetts General Hospital, Boston (D.M.S.); Mayo Clinic, Rochester, MN (D.R.H.); Centers for Medicare & Medicaid Services, Baltimore, MD (R.B.H.); Emory University School of Medicine, Atlanta, GA (V.H.T.); and University of Florida, Jacksonville (F.H.E.).
John S
JS
Rumsfeld
From the Duke University Medical Center, Durham, NC (S.M.O., J.M.B., D.D., E.D.P.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Denver VA Medical Center, CO (J.S.R.); Massachusetts General Hospital, Boston (D.M.S.); Mayo Clinic, Rochester, MN (D.R.H.); Centers for Medicare & Medicaid Services, Baltimore, MD (R.B.H.); Emory University School of Medicine, Atlanta, GA (V.H.T.); and University of Florida, Jacksonville (F.H.E.).
J Matthew
JM
Brennan
From the Duke University Medical Center, Durham, NC (S.M.O., J.M.B., D.D., E.D.P.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Denver VA Medical Center, CO (J.S.R.); Massachusetts General Hospital, Boston (D.M.S.); Mayo Clinic, Rochester, MN (D.R.H.); Centers for Medicare & Medicaid Services, Baltimore, MD (R.B.H.); Emory University School of Medicine, Atlanta, GA (V.H.T.); and University of Florida, Jacksonville (F.H.E.).
David M
DM
Shahian
From the Duke University Medical Center, Durham, NC (S.M.O., J.M.B., D.D., E.D.P.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Denver VA Medical Center, CO (J.S.R.); Massachusetts General Hospital, Boston (D.M.S.); Mayo Clinic, Rochester, MN (D.R.H.); Centers for Medicare & Medicaid Services, Baltimore, MD (R.B.H.); Emory University School of Medicine, Atlanta, GA (V.H.T.); and University of Florida, Jacksonville (F.H.E.).
David
D
Dai
From the Duke University Medical Center, Durham, NC (S.M.O., J.M.B., D.D., E.D.P.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Denver VA Medical Center, CO (J.S.R.); Massachusetts General Hospital, Boston (D.M.S.); Mayo Clinic, Rochester, MN (D.R.H.); Centers for Medicare & Medicaid Services, Baltimore, MD (R.B.H.); Emory University School of Medicine, Atlanta, GA (V.H.T.); and University of Florida, Jacksonville (F.H.E.).
David R
DR
Holmes
From the Duke University Medical Center, Durham, NC (S.M.O., J.M.B., D.D., E.D.P.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Denver VA Medical Center, CO (J.S.R.); Massachusetts General Hospital, Boston (D.M.S.); Mayo Clinic, Rochester, MN (D.R.H.); Centers for Medicare & Medicaid Services, Baltimore, MD (R.B.H.); Emory University School of Medicine, Atlanta, GA (V.H.T.); and University of Florida, Jacksonville (F.H.E.).
Rosemarie B
RB
Hakim
From the Duke University Medical Center, Durham, NC (S.M.O., J.M.B., D.D., E.D.P.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Denver VA Medical Center, CO (J.S.R.); Massachusetts General Hospital, Boston (D.M.S.); Mayo Clinic, Rochester, MN (D.R.H.); Centers for Medicare & Medicaid Services, Baltimore, MD (R.B.H.); Emory University School of Medicine, Atlanta, GA (V.H.T.); and University of Florida, Jacksonville (F.H.E.).
Vinod H
VH
Thourani
From the Duke University Medical Center, Durham, NC (S.M.O., J.M.B., D.D., E.D.P.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Denver VA Medical Center, CO (J.S.R.); Massachusetts General Hospital, Boston (D.M.S.); Mayo Clinic, Rochester, MN (D.R.H.); Centers for Medicare & Medicaid Services, Baltimore, MD (R.B.H.); Emory University School of Medicine, Atlanta, GA (V.H.T.); and University of Florida, Jacksonville (F.H.E.).
Eric D
ED
Peterson
From the Duke University Medical Center, Durham, NC (S.M.O., J.M.B., D.D., E.D.P.); Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.); Denver VA Medical Center, CO (J.S.R.); Massachusetts General Hospital, Boston (D.M.S.); Mayo Clinic, Rochester, MN (D.R.H.); Centers for Medicare & Medicaid Services, Baltimore, MD (R.B.H.); Emory University School of Medicine, Atlanta, GA (V.H.T.); and University of Florida, Jacksonville (F.H.E.).
Fred H
FH
Edwards
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D001499:Bayes Theorem; D005260:Female; D006302:Health Services Research; D054625:Healthcare Disparities / Q000639:trends*; D017052:Hospital Mortality / Q000639:trends*; D006761:Hospitals / Q000639:trends*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008390:Markov Chains; D009010:Monte Carlo Method; D015999:Multivariate Analysis; D016017:Odds Ratio; D017064:Process Assessment, Health Care / Q000639:trends*; D019984:Quality Indicators, Health Care / Q000639:trends*; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000401:mortality* / Q000639:trends*; D016896:Treatment Outcome
aortic stenosis; case-mix adjustment; outcomes analysis; outcomes research; transcatheter aortic valve replacement