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

Abstract

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." 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. This error is of concern because the accurate calculation of days at home relies on complete admission and discharge claims data. While the US Centers for Medicare & Medicaid Services captures all claims for Medicare fee-for-service patients, the claims for Medicare Advantage patients are incompletely captured in these files.Our original analysis included 1005 patients (507 patients in the TAVR group and 498 patients in the SAVR group), and our conclusion was that the mean (SD) days at home at 1 year was higher in patients who underwent TAVR vs SAVR (339.3 [63.7] vs 330.5 [64.8] days; difference, 8.8 days [95% CI, 0.8-16.7 days]; P = .03). In a new analysis excluding Medicare Advantage patients, we found that 687 Medicare fee-for-service patients (333 patients in the TAVR group and 354 in the SAVR group) had a mean (SD) days at home at 1 year that was still significantly higher in patients who underwent TAVR vs those who underwent SAVR and to a greater degree (340.8 [57.1] vs 326.2 [70.4] days; difference, 14.7 days [95% CI, 5.1-24.2 days]; P = .003). The difference in this result compared with our original findings was primarily due to underascertained skilled nursing facility days in the Medicare Advantage cohort. In addition, with the new analysis, there are minor numerical changes in the text, the Table , and the Figure. We apologize to the readers and editors of JAMA Cardiology for any confusion this has caused. We have requested that the article be corrected. 2

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. This article was corrected online.…”