Trends and Late Outcomes in Elderly Patients Undergoing Mitral Valve Interventions in the United States.
Academic Article
Overview
abstract
BACKGROUND: Mitral valve intervention improves clinical outcomes in selected patients with severe mitral regurgitation; less is known about the use trends and long-term outcomes of different mitral intervention strategies in real-world patients. OBJECTIVES: The aim of this study was to describe use trends in mitral valve intervention and identify factors contributing to 5-year mortality in elderly patients. METHODS: The fee-for-service Centers for Medicare and Medicaid Services claims database was used to identify patients ≥65 years of age hospitalized for surgical or transcatheter mitral valve intervention between January 1, 2017, and December 31, 2022. The primary outcome was 5-year mortality. RESULTS: There were 172,478 mitral valve interventions identified over the 5-year period. The number of mitral valve interventions, indexed per 100,000 Medicare Part A beneficiaries, increased by 9.2% over this period. The incidence of surgery declined by 15.7% whereas transcatheter edge-to-edge repair (M-TEER) increased by 94.8% and transcatheter mitral valve replacement (TMVR) increased by 100%. In-hospital mortality rates were 6.9% for surgery, 4.0% for TMVR, and 1.5% for M-TEER. Five-year mortality was 39.5% after surgery, 55.1% after TMVR, and 61.9% after M-TEER. Among patients at low frailty risk, 5-year mortality rates were 24.4%, 45.8%, and 52.2% for surgery, TMVR, and M-TEER, respectively; among patients at intermediate frailty risk, they were 44.8%, 62.2%, and 70.7%, respectively; among those at high frailty risk, they were 57.8%, 74.2%, and 80.6%, respectively. Quartiles of social vulnerability were incrementally associated with higher mortality. CONCLUSIONS: Mitral valve interventions in elderly patients are increasing over time, driven by transcatheter therapies. Five-year mortality varied by type of intervention and was significantly influenced by frailty and social vulnerability.
