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

Evolutionary and anthropological approaches towards understanding human need for psychotropic and mood altering substances

Human addiction to psychotropic and mood altering substances is an ongoing international problem. While the phenomenon of psychoactive drug use has received considerable theoretical attention there need to be more comparative approaches into this area. Evolutionary and anthropological approaches for understanding human need for psychotropic and mood altering substances offer the reader various insightful angles for analyzing this phenomenon. While evolutionary approaches investigate the evolutionary behaviors and mechanisms of human ancestral psychotropic use, anthropological approaches emphasize the social and religious meanings of individual drug use. While each approach proffers different ideas, a comparative approach, which is utilized in this study, may provide a novel and invaluable insight for understanding human need for psychotropic and mood-altering substances