Identifying Early Disease Progression in Tricuspid Regurgitation When Echocardiographic Imaging Data Is Unavailable

Speaker(s)

Barker C1, Kemp L2, He SX3, Mollenkopf S2, Gunnarsson C4, Ryan MP5, Cohen DJ6
1Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA, 2Edwards Lifesciences, Irvine, CA, USA, 3Edwards Lifesciences, La Palma, CA, USA, 4Gunnarsson Consulting, Jupiter, FL, USA, 5MPR Consulting, Cincinnati, OH, USA, 6Cardiovascular Research Foundation, New York, NY, USA

Presentation Documents

OBJECTIVES: Identification of disease progression for Tricuspid Regurgitation (TR), a form of valvular heart disease that contributes to high healthcare utilization and can lead to death, could help physicians determine candidates for advanced therapies and improve care management. Many real-world databases do not include echocardiography parameters, and proxy definitions are used to approximate disease severity. This study applies a disease severity proxy definition from a linked claims and electronic health record (EHR) dataset to attempt to identify disease progression in TR.

METHODS: This retrospective observational cohort study applies signs and symptoms rules selected by expert physicians to identify TR patients who have not yet reached clinical significance upon entry to the Optum Market Clarity database in the years 2007-2022. TR patients with a record of heart failure hospitalization or at least three symptoms from a seven-symptom list were excluded for having reached clinical significance. A Kaplan-Meier curve was generated to measure the proportion of remaining patients who reached clinical significance at 1, 5 and 10 years based on their initial symptom burden (zero, one or two symptoms).

RESULTS: Included patients had a mean age of 69 years; 54% were female, and 26% were non-white. For TR patients with two symptoms at database entry, a larger proportion reached clinical significance at 1, 5 and 10 years (15.9%, 46.9%, 76.1%) compared to those with one (3.9%, 21%, 50.2%) or no symptoms (1.3%, 9.5%, 32.6%). TR patients with atrial fibrillation or heart disease and/or other valve disease exhibited faster disease progression for each symptom cohort compared to those without.

CONCLUSIONS: Proxy rules from an administrative claims and EHR linked dataset were able to differentiate the TR progression rate between patients cohorts with varying levels of symptoms at baseline. Understanding which TR patient populations progress in their disease faster may help physicians prioritize patient care.

Code

SA70

Topic

Epidemiology & Public Health, Study Approaches

Topic Subcategory

Electronic Medical & Health Records

Disease

Cardiovascular Disorders (including MI, Stroke, Circulatory), Medical Devices