NCDR UPDATE
The value of TAVR has been clearly established in showing benefits in even moderate-risk patients with AS .
TAVR to their patients , because individuals whom they referred to the valve center were more likely to strongly prefer TAVR at the time of the initial consult than patients referred by non-cardiologists ( 47 % vs . 31 %; p = 0.003 ).
How Does TAVR Impact Readmissions ? And Who ’ s Better at Referral ?
Sreekanth Vemulapalli , MD , and colleagues from the Duke Clinical Research Institute used data from The Society of Thoracic Surgeons ( STS ) ACC TVT Registry™ to analyze pre- and post-TAVR hospitalizations in nearly 24,000 patients undergoing transcatheter aortic valve replacement ( TAVR ). In the year after TAVR , patients have fewer heart failure ( HF ) admissions ( 20.4 % vs . 11.4 %, respectively ; p < 0.001 ) and fewer any cause hospital admissions ( 61.7 % vs . 51.7 %, respectively ; p < 0.001 ). This translated to decreased Medicare costs for patients who remained alive 1-year post-TAVR .
The value of TAVR has been clearly established in showing benefits in even moderate-risk patients with aortic stenosis ( AS ). Timeliness of referral for these patients is important , but until now there has been little information regarding referral patterns .
Cassandra Ramm , MSN , AGNP-C , of the University of North Carolina was first-author of a poster evaluating nine large valve treatment centers participating in the ACC ’ s Championing Care for the Patient with Aortic Stenosis initiative . Among 454 patients referred for AS management , non-cardiologists did a better job , referring patients earlier in the disease course than cardiologists .
According to the valve center physicians , patients referred by cardiologists were more likely to have been referred “ late ” or “ too late ” ( 14 % vs . 7 %, p = 0.004 ), whereas non-cardiologists were more likely to refer “ too early ” ( 12 % vs . 3 %; p = 0.04 ).
Also , patients referred by cardiologists were more likely to have advanced HF ( New York Heart Association functional class IV : 31 % vs . 7 %; p < 0.0001 ) and trended towards higher STS risk scores ( p = 0.06 ) than those referred by non-cardiologists .
Cardiologists appear to be good at explaining
Ezetimibe Gets Little Respect
ACC ’ s 2016 Annual Scientific Session in Chicago featured a number of studies using data from the ACC ’ s NCDR registries . In one , William Wang , MS , a 3 rd -year medical student at the Duke Clinical Research Institute , looked at ezetimibe use as an adjunct to statin therapy .
Ezetimibe has been approved for lipid-lowering in the United States since 2002 , and , recently , the IMPROVE-IT study demonstrated its benefits on clinical outcomes when added to a statin postinfarction . 1 The new data come from an analysis of 13,738 MI patients aged 65 years or older discharged alive from 347 hospitals in the U . S . Three-quarters ( 74 %) of patients were prescribed statin alone , 6 % received a statin plus ezetimibe , 1 % received ezetimibe alone , and 19 % received neither . Tracy Wang , MD , senior author of the study , said the findings “ were unexpected ,” with ezetimibe “ rarely added to statin therapy , even in patients with high LDL cholesterol levels who might have benefited from aggressive secondary prevention . This seems to reflect a lack of awareness of the potential utility of ezetimibe in this population .”
The new data make a good benchmark and can be used for later comparison to determine the results of IMPROVE-IT will change ezetimibe use in this setting . ■
1 . Cannon CP , Blazing MA , Giugliano RP , et al . N Engl J Med . 2015 ; 372:2387-97 .
36 CardioSource WorldNews : Interventions May / June 2016