• Transcatheter Mitral Valve Repair Has ‘Significant’ Benefit for 1-Year Hospitalizations

    Transcatheter mitral valve repair (TMVr) has a “significant and sustained” effect in reducing both all-cause and heart failure (HF)-related hospitalizations 1 year after procedure compared with the year prior, analysis of new population data reports.

    Published online Monday and in the Oct. 25 issue of JACC: Cardiovascular Interventions, the new study noted that while TMVr has emerged as the treatment of choice for selected patients with mitral regurgitation (MR), the impact of such procedures on hospital utilization remains unclear.

    Led by Andrew Czarnecki, MD, MSc, from ICES, Toronto; the Sunnybrook Health Sciences Centre, Toronto; and the University of Toronto, the team determined the effect of TMVr on hospitalization rates by assessing pre- and postprocedural hospitalization patterns in all patients who underwent TMVr in Ontario between 2011 and 2017.

    “Our study demonstrated important and significant reductions in hospitalizations in a real-world, population-based cohort of patients with significant MR,” said the team.

    “Given the high prevalence of comorbidities in these elderly patients who are not candidates for operative intervention, these are important and influential results for both patients and policy makers.

    Study details

    Czarnecki and colleagues analyzed data from 523 patients included in the observational study.

    The team assessed hospitalization person-year rates in the years before and after TMVr, with four pre-defined intervals: 1 to 30 days, 31 to 90 days, 91 to 182 days and 183 to 365 days. Main outcomes were all-cause and HF hospitalizations.

    “In the year preceding TMVr, 66.2% of patients were hospitalized compared with 47.4% in the year following,” said the authors, noting that there was a stepwise rise in hospitalization rates in the year prior to TMVr, with the highest rates in the 30 days before the procedure.

    All postprocedural periods had significantly lower hospitalization rates, they said, noting that the data suggest that an acute decline in health status may have prompted the intervention.

    “The lowest rates of hospitalization occurred in the second half of the year after the intervention, an impressive finding given the elderly and frail real-world population under investigation,” Czarnecki and colleagues said.

    Overall, the adjusted rate ratios for all-cause and HF-related hospitalization in the year after TMVr were 0.65 (95% confidence interval [CI]: 0.56-0.76) and 0.38 (95% CI: 0.29-0.51), respectively.

    Moreover, the authors noted that the data suggest that TMVr affected the background rate of hospitalization for the cohort.

    “Given the high levels of comorbid conditions seen in this elderly population, this finding is somewhat unexpected and suggests that there may be a role for more broad application of TMVr,” they said.

    “It is likely that there is significant underutilization, given the high prevalence of MR, particularly in the elderly population, which is most often unsuitable for surgical intervention.”

    They concluded that additional studies will be required to determine which patients are most likely to benefit from reductions in hospitalization, “as this may have significant impact on health care costs.”

    Quality of life, not quantity of life

    Writing in an accompanying editorial, Daniel Kalbacher, MD, and Niklas Schofer, MD, from the University Medical Center Hamburg-Eppendorf, Hamburg, Germany, noted that rehospitalization for HF is one of the main challenges in modern medicine, impacting survival rates of affected patients and burdening health care systems and health economics.

    The editorialists said the authors of the new study should be congratulated on their “important and well-conducted analysis,” adding that a major strength of the study is that public health care data could be used, providing complete follow-up information on all study subjects.

    They added that the findings are important, as preventing all-cause rehospitalizations equals a tangible improvement in quality of life for patients.

    “For these elderly patients, the main incentive to undergo TEER [transcatheter edge-to-edge repair] might not be to increase the quantity, but rather the quality of life,” they said.

    “Further evidence is needed to correlate TEER and rehospitalization rates, as this might be the most relevant outcome for the patient cohort currently treated by TEER. “

    Sources:

    Czarnecki A, Han L, Abuzeid W, et al. Impact of Transcatheter Mitral Valve Repair on Preprocedural and Postprocedural Hospitalization Rates. JACC Cardiovasc Interv 2021;14:2274-2281.

    Kalbacher D, Schofer N. Reducing Rehospitalization Rates by Transcatheter Mitral Edge-to-Edge Repair: A Matter of Quality of Life. JACC Cardiovasc Interv 2021;14:2282-2284.

    Image Credit: Monkey Business – stock.adobe.com

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