Welcome to the STS-ACC TVT registry case scenario where we will discuss patient inclusion in the mortality metric keys for base, 30-day follow-up, and one-year follow-up submissions. For this scenario, a 79-year-old male presents for a TAVR procedure where the TAVR device was successfully delivered. Even after the device was delivered, the patient complained of chest pain, shortness of breath, and became hemodynamically unstable. The TEE showed a pericardial effusion with a tamponade from myocardial perforation, later documented in the medical record. The pericardiocentesis was unsuccessful. The patient was placed on ECMO for hemodynamic compromise, and a pericardial window was performed and the perforation repaired. The patient ultimately did not respond to treatment and dies on day 18 post-procedure, where sequence 10-105, discharge status, is coded as deceased. Our question is, will the patient appear in the numerator for metric key 10-724, observed mortality, for the TAVR base procedure? Number one, no, or number two, yes. Please take a few moments to review the documentation before making a final selection. And the answer is yes. The patient died on the base procedure, and the discharge status is coded yes in sequence 10-105. Therefore, the numerator inclusion is met, and the patient will appear in the numerator for metric key 10-724. We understand that this question is very simple, but it sets us up for the next few questions that come in to the registry on a frequent basis. For bonus question one, we are going to use the same documentation with one exception. In this scenario, the patient had a prolonged hospitalization, but died on day 38 post-procedure. Will the patient appear in the numerator for metric key 10-724, base procedure observed mortality, and in metric key 10-227, 30-day follow-up observed mortality? Number one, no, or number two, yes. And the answer is no. When the patient dies on day 38 post-procedure while still in the same episode of care, metric key 10-724 would include the patient in the numerator, as the patient died on the base procedure, even if there was a prolonged hospitalization. And sequence 10-105, discharge status, was coded as deceased. The patient would not be included in the numerator for metric key 10-227, 30-day follow-up observed mortality, because the post-procedure length of stay was greater than or equal to 30 days. When the patient dies on the base procedure, no additional follow-ups are required. In fact, if a follow-up is completed on a patient who died on the base procedure and is coded as deceased in sequence 10-105, it will produce an error in the DQR submission. The same logic would apply if the patient died after discharge and the death is entered for the 30-day follow-up. A one-year follow-up is not required. For bonus question number two, please use the same documentation as bonus question number one. The patient died on the base procedure at day 18 post-device insertion. Why does my patient appear in the numerator for metric key 10-227, 30-day follow-up observed mortality, and metric key 10-584, one-year follow-up observed mortality, when no follow-ups were completed? When the patient dies on the base procedure with a length of stay less than or equal to 30 days post-procedure, the patient will appear in the numerator for metric key 10-227, 30-day follow-up observed mortality, because numerator inclusion is met when the patient death occurs on the base procedure with a length of stay of 18 days post-procedure. Likewise, the patient meets the numerator inclusion criteria for one-year follow-up observed mortality metric key 10-584 for the coding of deceased at discharge in sequence 10-105 with a length of stay less than or equal to 30 days post-procedure. While this may seem like the patient death is being captured three times, the patient death is only captured once for the base procedure, but the patient death is tracked through the one-year follow-up. New scenario. My patient had a successful TAVR and was discharged without complications. The one-year follow-up was completed on day 325 post-procedure. We received notification that the patient died on day 389 post-procedure. A question, do I need to enter this patient death into the data collection tool as an additional follow-up, even though the one-year follow-up is already completed? And the answer, when a one-year follow-up has been entered into the DCT, your obligation to the registry is complete for that patient. When a one-year follow-up has already been completed, entering a patient death that occurs after day 365 post-procedure is at the discretion of your facility. The DCT will accept the information as the death is within 305 to 425 day post-procedure timeframe, but the data will not be harvested for inclusion in the numerator for metric 10584, one-year follow-up observed mortality, as the patient death is greater than or equal to 365 days post-procedure and no longer meets numerator inclusion. Thank you for viewing the STS-ACC TVT Registry Case Scenario.

chronic kidney disease

transcatheter mitral valve repair

dialysis initiation

creatinine levels

intra-post-procedure event

TAVR procedure

mortality metrics

patient deaths

registry inclusion

data entry