Economic Benefits of Surgical Aortic Valve Replacement on Patients With Symptomatic Aortic Valve Regurgitation

• Published in: Journal of the American Heart Association 2024-08, Vol.13 (16), p.e9983
• Main Authors: Still, Sasha Anne, Ryan, Michael, Gunnarsson, Candace, Heidrich, Natalie, Davies, James E
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; aortic regurgitation; Aortic Valve - surgery; aortic valve disease; Aortic Valve Insufficiency - economics; Aortic Valve Insufficiency - mortality; Aortic Valve Insufficiency - surgery; Cost-Benefit Analysis; Databases, Factual; Female; Health Care Costs - statistics & numerical data; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - economics; Humans; Male; Middle Aged; Retrospective Studies; SAVR; Time Factors; Treatment Outcome; United States - epidemiology
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.124.035278

Aortic regurgitation is distinguished by the backflow of blood from the aorta into the left ventricle. American College of Cardiology/American Heart Association guidelines recommend surgical aortic valve replacement (SAVR) for patients with symptomatic aortic regurgitation (sAR). This study estimates the difference in mortality, health care use, and costs between patients with sAR who receive SAVR within 12 months of diagnosis versus those who do not. We used the Optum United Healthcare database to identify 132 317 patients diagnosed with sAR from 2016 to 2021 who had at least 6 months of enrollment before sAR and 12 months of enrollment after. Criteria were no history of aortic stenosis or transcatheter aortic valve replacement and ≥2 visits for heart failure, angina, dyspnea, or syncope. Outcomes were all-cause mortality, health care use, and annualized cost. Baseline differences in demographics and comorbidities were adjusted with inverse propensity score weighting. We modeled survival and estimated health care use and costs using Cox proportional hazards and general linear models, respectively. Of the 132 317 patients, 400 underwent SAVR within 12 months of diagnosis. They were on average younger, more often men, and with a slightly higher Elixhauser Comorbidity Index score. After inverse propensity score weighting, patients with sAR who had SAVR had lower mortality, fewer inpatient and emergency department visits, fewer hospital days, and lower annualized cost. SAVR performed within 12 months of an sAR diagnosis is associated with improved mortality and lower annualized health care use and costs. These clinical and economic benefits should be considered when managing patients with sAR.