Research Article

Impact of Pacemaker Implantation on 12-Month Resource Utilization Following TAVR Hospitalization

Steven D Culler*, Aaron D Kugelmass, David J Cohen, Matthew R Reynolds, Phillip P Brown, April W Simon and Marc R Katz

Published: 21 October, 2019 | Volume 4 - Issue 3 | Pages: 164-170

Purpose: This study reports resource utilization during a Medicare Beneficiary’s (MBs) Transcatheter Aortic Valve Replacement (TAVR) index hospitalization and all subsequent encounters for 12 months and compares data between MBs who did or did not receive a pacemaker implantation (PPM) during their index hospitalization.

Method: This retrospective study examined Medicare hospital claims from January 1, 2014 through June 30, 2015. 15,533 MBs who survived for 365 days were studied. Information from all encounters during the study period was combined to compare hospital resource utilization and outcomes.

Results: 14.8% of MBs had a PPM during the index hospitalization. 46.0% of MBs had at least one readmission to a hospital during the 365-day follow-up period. 54.6% of MB’s first hospital readmission occurred within 90 days of their TAVR discharge date. Average total Medicare reimbursement for all hospitalizations was $60,638 ± $28,974 associated with average total hospital length of stay of 11.2 ± 11.7 days. After adjusting for demographics and 47 comorbid conditions, MBs receiving a PPM during the index TAVR had significantly higher estimated Medicare reimbursement ($5,132) and longer total length of stay (1.8 days) for the entire study period than MBs not receiving a PPM.

Conclusion: Total Medicare reimbursement and hospital LOS were significantly higher among MBs that had a PPM implantation during their index admission; however, there were no significant differences in readmission rates, readmission length of stay, or days to first readmission during the follow-up period between the two study cohorts.

Read Full Article HTML DOI: 10.29328/journal.jccm.1001060 Cite this Article Read Full Article PDF


TAVR; Medicare reimbursement Episode of care; Hospital resources


  1. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016; 374: 1609-1620. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27040324                
  2. Mack MJ, Leon MB, Smith CR, Miller DC, Moses JW, et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomized controlled trial. Lancet. 2015; 385: 2477-2484. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25788234
  3. Kodali SK, Williams MR, Smith CR, Svensson LG, Webb JG, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med. 2012; 366: 1686-1695. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22443479
  4. Holmes DR Jr, Nishimura RA, Grover FL, Brindis RG, Carroll JD, et al. Annual outcomes with transcatheter valve therapy: from the STS/ACC TVT Registry. J Am Coll Cardiol. 2015; 66 2813-2823. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26652232
  5. Holmes DR Jr, Brennan JM, Rumsfeld JS, Dai D, O'Brien SM, et al. Clinical outcomes at 1 year following transcatheter aortic valve replacement. JAMA. 2015; 313: 1019-1028. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25756438
  6. Grover FL, Vemulapalli S, Carroll JD, Edwards FH, Mack MJ, et al. 2016 annual report of the society of thoracic surgeons/American college of cardiology transcatheter valve therapy registry. The Annals of Thoracic Surgery. 2017; 103: 1021-1035. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27956264
  7. Reinöhl J, Kaier K, Reinecke H, Schmoor C, Frankenstein L, et al. Effect of availability of transcatheter aortic-valve replacement on clinical practice. N Engl J Med. 2015; 373: 2438-2447. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26672846
  8. Culler SD, Cohen DJ, Brown PP, Kugelmass AD, Reynolds MR, et al. Trends in Aortic Valve Replacement Procedures Between 2009 and 2015: Has Transcatheter Aortic Valve Replacement Made a Difference? Ann Thorac Surg. 2018; 105: 1137-1143. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29394992
  9. Reynolds MR, Magnuson EA, Lei Y, Wang K, Vilain K, et al. Cost-effectiveness of transcatheter aortic valve replacement compared with surgical aortic valve replacement in high-risk patients with severe aortic stenosis: results of the PARTNER (Placement of Aortic Transcatheter Valves) trial (Cohort A). J Am Coll Cardiol. 2012; 60: 2683-2692. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23122802
  10. Reynolds MR, Magnuson EA, Wang K, Lei Y, Vilain K, et al. Cost-Effectiveness of Transcatheter Aortic Valve Replacement Compared With Standard Care Among Inoperable Patients With Severe Aortic Stenosis Clinical Perspective: Results From the Placement of Aortic Transcatheter Valves (PARTNER) Trial (Cohort B). Circulation. 2012; 125: 1102-1109. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22308299
  11. Arnold SV, Lei Y, Reynolds MR, Magnuson EA, Suri RM, et al. Costs of periprocedural complications in patients treated with transcatheter aortic valve replacement: results from the Placement of Aortic Transcatheter Valve trial. Circ Cardiovasc Interv. 2014; 7: 829-836. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25336467
  12. Reynolds MR, Lei Y, Wang K, Chinnakondepalli K, Vilain KA, et al. Cost-effectiveness of transcatheter aortic valve replacement with a self-expanding prosthesis versus surgical aortic valve replacement. J Am Coll Cardiol. 2016; 67: 29-38. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26764063
  13. Fadahunsi OO, Olowoyeye A, Ukaigwe A, Li Z, Vora AN, et al. Incidence, predictors, and outcomes of permanent pacemaker implantation following transcatheter aortic valve replacement: analysis from the US Society of Thoracic Surgeons/American College of Cardiology TVT Registry. JACC Cardiovasc Interv. 2016; 9: 2189-2199. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27832844
  14. Siontis GC, Jüni P, Pilgrim T, Stortecky S, Büllesfeld L, et al. Predictors of permanent pacemaker implantation in patients with severe aortic stenosis undergoing TAVR: a meta-analysis. J Am Coll Cardiol. 2014; 64: 129-140. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25011716
  15. Kolte D, Khera S, Sardar MR, Gheewala N, Gupta T, et al. Thirty-day readmissions after transcatheter aortic valve replacement in the United States: insights from the nationwide readmissions database. Circ Cardiovasc Interv. 2017; 10: e004472. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28034845
  16. Chamandi C, Barbanti M, Munoz-Garcia A, Latib A, Nombela-Franco L, et al. Long-Term Outcomes in Patients With New Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv.. 2018; 11: 301-310. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29413244
  17. Centers for Medicare and Medicaid Services. Bundled Payments for Care Improvement Advanced (BPCI Advanced) Voluntary Bundled Payment Model. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-01-10.html.
  18. Ream K, Sandhu A, Valle J, Weber R, Kaizer A, et al. Ambulatory Rhythm Monitoring to Detect Late High-Grade Atrioventricular Block Following Transcatheter Aortic Valve Replacement. J Am Coll Cardiol. 2019; 73: 2538-2547. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31118148

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