Increased Health Care Utilization, Expenses in Patients With Tricuspid Regurgitation, Heart Failure

In patients with tricuspid regurgitation, comorbid right-sided heart disease (RSHD), other valve disease (OVD), or heart failure (HF) is associated with increased health care utilization, according to a study published online in the Journal of Comparative Effectiveness Research. 

“Tricuspid regurgitation is a prevalent valvular disorder in the USA and most frequently occurs when dilation of the right ventricle results in the backward flow of blood through the tricuspid valve into the right atrium,” researchers wrote. “Several conditions that cause right-ventricle dilation are associated with tricuspid regurgitation.” 

To investigate the burden of RSHD, OVD, and HF in patients with tricuspid regurgitation, researchers used real-world data from Optum’s de-identified, all-payer, integrated database of United Healthcare claims and Humedica electronic health records to construct a hierarchical cohort. Among 33,686 patients in the analysis, 19.6% had tricuspid regurgitation only, 26.6% had tricuspid regurgitation with HF, 36.7% had tricuspid regurgitation with OVD (but no HF), and 17.1% had tricuspid regurgitation with RSHD only. 

Comorbid RSHD, OVD, or HF in patients with tricuspid regurgitation was each independently linked with increased annualized hospitalizations, hospital days, and costs, compared with patients with tricuspid regurgitation alone, researchers found. Across all measures, HF had the greatest impact.

Patients with tricuspid regurgitation with HF had an annualized all-cause hospitalization burden of 0.74, or about 8 hospitalizations every 11 years, compared with a 0.54 annualized all-cause hospitalization burden for patients with tricuspid regurgitation alone, according to the study. Patients with tricuspid regurgitation with HF also had the most annualized hospital days (7.1, compared with 5.5 for tricuspid regurgitation alone).  

“HF had the most significant impact on overall expenditures, with a percent change of 15%,” researchers added. “Unfortunately, we could not calculate total dollar amounts because of restrictions using Optum’s data. However, previous studies have shown that annualized expenditures of patients with tricuspid regurgitation and HF were greater than those with tricuspid regurgitation alone ($42,255 vs $29,985, respectively).” 

—Jolynn Tumolo

Reference

Barker CM, Cork DP, McCullough PA, et al. Healthcare utilization in clinically significant tricuspid regurgitation patients with and without heart failure [published online ahead of print, 2020 Nov 11]. J Comp Eff Res. 2020;10.2217/cer-2020-0198. doi:10.2217/cer-2020-0198