Real-World Clinical Outcomes and Health Care Utilization in Patients With Severe Tricuspid Regurgitation

Background

Patients with severe tricuspid regurgitation (TR) are at risk for significant morbidity and mortality. Data on long-term clinical outcomes and health care resource utilization for this population are limited.

Methods

We used the Optum Market Clarity database from 2016 to 2022 to identify patients with severe TR based on a combination of physician documentation, claims for severe TR, and echocardiography within 3 months of the diagnosis. Event rates through 3-year follow-up were calculated using Kaplan-Meier methodology, and health care resource use and expenditures were calculated using the Bang and Tsiatis censoring method. Secondary analyses were performed among patients with severe, symptomatic TR, which required additional physician documentation of prespecified signs or symptoms.

Results

We identified 1190 patients with severe TR and no previous tricuspid valve surgery between 2016 and 2022. The mean age was 72 years, and 67% were female. Baseline comorbidities were common, with a mean Elixhauser score of 9.4 ± 4.0 (range, 0-31). Of patients with detailed echocardiographic data available (N = 322), 46% had normal left ventricular ejection fraction. Three-year rates of all-cause mortality, stroke, and any tricuspid valve surgery were 47.9, 19.1, and 7.5%, respectively. Health care–related resource utilization was high, with cumulative 3-year costs of approximately $127,000/patient.

Conclusions

Over 3 years of follow-up, patients with severe TR had high rates of death and adverse clinical events and incurred substantial health care costs. Longer-term data regarding the impact of transcatheter interventions for severe TR on clinical outcomes and costs are needed to better understand the value of these novel therapies.