Days at Home After Transcatheter vs Surgical Aortic Valve Replacement in Intermediate-Risk Patients

Abstract

Days at home, an emerging patient-centered outcome that quantifies time spent alive and out of health care facilities, has not been fully described in trials evaluating transcatheter aortic valve replacement (TAVR). We sought to compare the total number of days spent at home within the first year among intermediate-risk patients participating in a randomized clinical trial of TAVR with a self-expanding bioprosthesis vs surgical aortic valve replacement (SAVR).

Days at Home After Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients

“…[4][5][6] This emerging outcome may be important to individuals with severe aortic stenosis seeking to maximize postprocedural functional status and independence, and thus could potentially aid in the decision-making for the mode of aortic valve replacement. We previously examined DAH in high- 7 and intermediate-risk 8 patients using the U.S. CoreValve High Risk trial and the Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients (SURTAVI) trial linked with Medicare claims and found that in the first year after the procedure, highrisk patients undergoing TAVR had ≈27 additional DAH compared with SAVR and that intermediate-risk patients had ≈15 more DAH compared with the surgical group. These differences were primarily due to longer postprocedural length of stay (LOS), excess mortality days, and more facility days after initial discharge, including time in skilled nursing facilities (SNFs).…”

Explanation for Error in Types of Medicare Patients Included in Aortic Valve Replacement Study

“…We reported that "that intermediate-risk patients undergoing TAVR had approximately 9 more days at home 1 year after the procedure compared with those undergoing SAVR as a result of shorter index hospitalizations and fewer days in SNFs [skilled nursing facilities] and rehabilitation." 1 Unfortunately, our original analysis mistakenly included Medicare Advantage patients. This error was recognized during linkage of another data set to the Medicare Provider Analysis and Review file, which primarily includes Medicare fee-for-service patients but was discovered to also contain records for Medicare Advantage patients.…”

“…To the Editor On behalf of my coauthors, I write to report important errors in our Research Letter, “Days at Home after Transcatheter vs Surgical Aortic Valve Replacement in Intermediate-Risk Patients” published Online First on October 20, 2021, and in the January 2022 issue of JAMA Cardiology. In this article, we reported the results of a post hoc analysis that was conducted between June 19, 2012, and June 30, 2018, of the Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients (SURTAVI) trial linked to Medicare claims.…”

“…We compared the total number of days spent at home within the first year among intermediate-risk patients participating in this trial of transcatheter aortic valve replacement (TAVR) with a self-expanding bioprosthesis vs surgical aortic valve replacement (SAVR). We reported that “that intermediate-risk patients undergoing TAVR had approximately 9 more days at home 1 year after the procedure compared with those undergoing SAVR as a result of shorter index hospitalizations and fewer days in SNFs [skilled nursing facilities] and rehabilitation.”…”

Errors in Text, Table, and Figure

“…In the Research Letter titled “Days at Home after Transcatheter vs Surgical Aortic Valve Replacement in Intermediate-Risk Patients,” published Online First on October 20, 2021, and in the January 2022 issue of JAMA Cardiology , Medicare Advantage patients were mistakenly included in the analysis, which resulted in errors in the text, the Table, and the Figure. A Letter of Explanation has been published that explains the errors.…”