Cardiovascular Events and Hospital Resource Utilization Pre and Post Transcatheter Mitral Valve Repair in High Surgical Risk Patients

Abstract Background MitraClip is an approved therapy for mitral regurgitation (MR) however, healthcare resource utilization pre and post MitraClip remains understudied. Methods and Results Patients with functional and degenerative MR at high surgical risk in the EVEREST II High-Risk Registry and REALISM Continued Access Study were linked to Medicare data. Pre- and post-MitraClip all-cause death, stroke, myocardial infarction (MI), heart failure (HF), and bleeding hospitalizations were identified. Inpatient costs, adjusted to 2010 US$, were calculated and event rate ratios and cost ratios were estimated with multivariable modeling. Among 403 linked patients, the mean age was 80 years, 60% were male, mean baseline LVEF was 49.6%, 83.3% were NYHA class III/IV, 78.2% were MR grade 3+/4+, and 63.3% had functional MR. All-cause hospitalization decreased from 1854 to 1435 / 1000 person-years, P < .001. HF hospitalization decreased following MitraClip (749 vs. 332 /1000 person-years, P < .001), but bleeding increased (199 vs 298 /1000 person-years, P < .001). Changes in stroke and MI were not statistically significant. Overall mean Medicare costs per patient were similar pre- and post-MitraClip though there was a significant decrease in mean costs among those that survived a full year after MitraClip ($18,131 [SD $25,130], vs. $11,679 [SD $22,486]; P = .02). Conclusions MitraClip was associated with a reduced rate of all-cause and HF hospitalizations and an increased rate of bleeding hospitalizations. One-year Medicare costs were reduced in those who survived a full year after the MitraClip procedure. Payors and providers seeking to reduce HF hospitalizations and associated Medicare costs may consider MitraClip among appropriate patients likely to survive 1 year. Clinical Trial Registration https://clinicaltrials.gov EVEREST II High Risk Registry (NCT-01940120) and EVEREST II REALISM (NCT-01931956).