3 research outputs found
a 1-year follow-up analysis based on German health insurance administrative data from 2008 to 2014
Objectives To describe the use of drug-eluting stents (DESs) in the largest
population of statutory health insurance members in Germany, including newly
developed bio-resorbable vascular scaffolds (BVSs), and to evaluate 1-year
complication rates of DES as compared with bare metal stents (BMSs) in this
cohort. Design Routine data analysis of statutory health insurance claims data
from the years 2008 to 2014. Setting The German healthcare insurance
Allgemeine Ortskrankenkasse covers approximately 30% of the German population
and is the largest nationwide provider of statutory healthcare insurance in
Germany. Participants and interventions We included all patients with a claims
record for a percutaneous coronary intervention (PCI) with either DES or BMS
and additionally, from 2013, BVS. Patients with acute myocardial infarction
(AMI) were excluded. Main outcome measure: major adverse cerebrovascular and
cardiovascular event (MACCE, defined as mortality, AMI, stroke and transient
ischaemic attack), bypass surgery, PCI and coronary angiography) at 1 year
after the intervention. Results A total of 243 581 PCI cases were included
(DES excluding BVS: 143 765; BVS: 1440; BMS: 98 376). The 1-year MACCE rate
was 7.42% in the DES subgroup excluding BVS and 11.29% in the BMS subgroup.
The adjusted OR for MACCE was 0.72 (95% CI 0.70 to 0.75) in patients with DES
excluding BVS as compared with patients with BMS. In the BVS group, the
proportion of 1-year MACCE was 5.0%. Conclusion The analyses demonstrate a
lower MACCE rate for PCI with DES. BVSs are used in clinical routine in
selected cases and seem to provide a high degree of safety, but data are still
sparse
Risk-related short-term clinical outcomes after transcatheter aortic valve implantation and their impact on early mortality: an analysis of claims-based data from Germany
Objectives
We aimed to define and assess risk-specific adverse outcomes after transcatheter aortic valve implantation (TAVI) in an all-comers patient population based on German administrative claims data.
Methods
Administrative claims data of patients undergoing transvascular TAVI between 2017 and 2019 derived from the largest provider of statutory health-care insurance in Germany were used. Patients’ risk profile was assessed using the established Hospital Frailty Risk (HFR) score and 30-day adverse events were evaluated. Multivariable logistic regression models were applied to investigate the relation of patients’ risk factors to clinical outcomes and, subsequently, of clinical outcomes to mortality.
Results
A total of 21,430 patients were included in the analysis. Of those, 51% were categorized as low-, 37% as intermediate-, and 12% as high-risk TAVI patients according to HFR score. Whereas low-risk TAVI patients showed low rates of periprocedural adverse events, TAVI patients at intermediate or high risk suffered from worse outcomes. An increase in HFR score was associated with an increased risk for all adverse outcome measures. The strongest association of patients’ risk profile and outcome was present for cerebrovascular events and acute renal failure after TAVI. Independent of patients’ risk, the latter showed the strongest relation with early mortality after TAVI.
Conclusions
Differentiated outcomes after TAVI can be assessed using claims-based data and are highly dependent on patients’ risk profile. The present study might be of use to define risk-adjusted outcome margins for TAVI patients in Germany on the basis of health-insurance data