The Healthcare Burden of Isolated Aortic Valve Insufficiency (AI): Analysis of a Large Health Insurance Database

The Healthcare Burden of Isolated Aortic Valve Insufficiency (AI): Analysis of a Large Health Insurance Database | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The Healthcare Burden of Isolated Aortic Valve Insufficiency (AI): Analysis of a Large Health Insurance Database Ibrahim Sultan, Michael Ryan, Candace Gunnarsson, Natalie Heidrich, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4420887/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 08 Feb, 2025 Read the published version in Scientific Reports → Version 1 posted 10 You are reading this latest preprint version Abstract Objective To analyze and compare the differences in mortality, healthcare utilization, and costs between patients with symptomatic and asymptomatic isolated aortic insufficiency (AI). Methods We utilized Optum® United Health Care database for US patients who had an AI claim between 2017 and 2022, with 12 months of continuous enrollment (baseline period) prior to diagnosis. Exclusion criteria were AVR during the baseline period or a diagnosis of aortic stenosis. Patients were split into two cohorts: those with symptoms (SAI) and those without (AAI). SAI patients had ≥ 2 visits for heart failure, angina, dyspnea, or syncope at baseline. Outcomes of interest were all-cause mortality, time to home health, time to SNF, annualized healthcare utilization, and annualized costs. We used the Cox proportional model to estimate mortality and general linear models to estimate healthcare utilization and costs. Outcomes were modeled separately. Results Of 249,660 patients, 58.23% were symptomatic; they were generally older and sicker than the AAI cohort, and less than 1% received AVR. Almost half of AAI patients were estimated to develop symptoms within 5 years post-diagnosis. SAI outcomes were consistently higher across all measured outcomes. Conclusions SAI patients have higher mortality, healthcare utilization, and costs than AAI. However, AI can progress quickly from asymptomatic to symptomatic. Early detection and timely interventions to slow the progression or address it surgically should be emphasized to limit the impact of AI. Health sciences/Cardiology Health sciences/Health care aortic valve disease SAVR symptomatic AI asymptomatic AI Full Text Additional Declarations Competing interest reported. Ibrahim Sultan,MD receives research support from Abbott, Artivion, Atricure, Edwards Lifesciences, Medtronic and Terumo Aortic. Michael Ryan,MS and Candace Gunnarsson, EdD, MA are paid consultants to Edwards Lifesciences. Natalie Heidrick, MS is an employee of Edwards Lifesciences. Prashanth Vallabhajosyula is a consultant for Terumo Aortic, Eurofins Diagnostics. Cite Share Download PDF Status: Published Journal Publication published 08 Feb, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 22 Nov, 2024 Reviews received at journal 18 Nov, 2024 Reviewers agreed at journal 03 Nov, 2024 Reviews received at journal 21 Jun, 2024 Reviewers agreed at journal 13 Jun, 2024 Reviewers invited by journal 09 Jun, 2024 Editor assigned by journal 09 Jun, 2024 Editor invited by journal 08 Jun, 2024 Submission checks completed at journal 06 Jun, 2024 First submitted to journal 14 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4420887","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":314455550,"identity":"e7317b48-479f-4baf-9ffd-4ea58fe71c1e","order_by":0,"name":"Ibrahim Sultan","email":"","orcid":"","institution":"University of Pittsburgh Medical Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ibrahim","middleName":"","lastName":"Sultan","suffix":""},{"id":314455552,"identity":"329869fc-77ad-49d9-b2b8-8f004d8ab937","order_by":1,"name":"Michael Ryan","email":"","orcid":"","institution":"MPR Consulting","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Michael","middleName":"","lastName":"Ryan","suffix":""},{"id":314455556,"identity":"cb0aa5db-6478-4804-9674-7a22337bfe6c","order_by":2,"name":"Candace Gunnarsson","email":"","orcid":"","institution":"Gunnarsson Consulting","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Candace","middleName":"","lastName":"Gunnarsson","suffix":""},{"id":314455557,"identity":"57356cbd-579f-43ad-be40-67407ebb67ab","order_by":3,"name":"Natalie Heidrich","email":"","orcid":"","institution":"Edwards Lifesciences (United States)","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Natalie","middleName":"","lastName":"Heidrich","suffix":""},{"id":314455558,"identity":"2247963f-08e0-45ae-965d-33586caac6ac","order_by":4,"name":"Prashanth Vallabhajosyula","email":"data:image/png;base64,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","orcid":"","institution":"Yale University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Prashanth","middleName":"","lastName":"Vallabhajosyula","suffix":""}],"badges":[],"createdAt":"2024-05-14 17:51:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4420887/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4420887/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-87179-1","type":"published","date":"2025-02-08T15:57:23+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":75930845,"identity":"e7b27df6-ee9c-4b67-ad72-6efbed6ef104","added_by":"auto","created_at":"2025-02-10 16:13:41","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":559024,"visible":true,"origin":"","legend":"","description":"","filename":"IsolatedAIBurdenManuscriptforNature572024.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4420887/v1_covered_d16be076-59b1-42c0-8cda-ee665e0e23f2.pdf"}],"financialInterests":"Competing interest reported. Ibrahim Sultan,MD receives research support from Abbott, Artivion, Atricure, Edwards Lifesciences, Medtronic and Terumo Aortic. Michael Ryan,MS and Candace Gunnarsson, EdD, MA are paid consultants to Edwards Lifesciences. Natalie Heidrick, MS is an employee of Edwards Lifesciences. Prashanth Vallabhajosyula is a consultant for Terumo Aortic, Eurofins Diagnostics.","formattedTitle":"The Healthcare Burden of Isolated Aortic Valve Insufficiency (AI): Analysis of a Large Health Insurance Database","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"aortic valve disease, SAVR, symptomatic AI, asymptomatic AI","lastPublishedDoi":"10.21203/rs.3.rs-4420887/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4420887/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo analyze and compare the differences in mortality, healthcare utilization, and costs between patients with symptomatic and asymptomatic isolated aortic insufficiency (AI).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e We utilized Optum\u0026reg; United Health Care database for US patients who had an AI claim between 2017 and 2022, with 12 months of continuous enrollment (baseline period) prior to diagnosis. Exclusion criteria were AVR during the baseline period or a diagnosis of aortic stenosis. Patients were split into two cohorts: those with symptoms (SAI) and those without (AAI). SAI patients had\u0026thinsp;\u0026ge;\u0026thinsp;2 visits for heart failure, angina, dyspnea, or syncope at baseline. Outcomes of interest were all-cause mortality, time to home health, time to SNF, annualized healthcare utilization, and annualized costs. We used the Cox proportional model to estimate mortality and general linear models to estimate healthcare utilization and costs. Outcomes were modeled separately.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOf 249,660 patients, 58.23% were symptomatic; they were generally older and sicker than the AAI cohort, and less than 1% received AVR. Almost half of AAI patients were estimated to develop symptoms within 5 years post-diagnosis. SAI outcomes were consistently higher across all measured outcomes.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eSAI patients have higher mortality, healthcare utilization, and costs than AAI. However, AI can progress quickly from asymptomatic to symptomatic. Early detection and timely interventions to slow the progression or address it surgically should be emphasized to limit the impact of AI.\u003c/p\u003e","manuscriptTitle":"The Healthcare Burden of Isolated Aortic Valve Insufficiency (AI): Analysis of a Large Health Insurance Database","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-20 15:19:54","doi":"10.21203/rs.3.rs-4420887/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-22T08:45:01+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-18T10:37:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"55150226639231113126481074967505322591","date":"2024-11-03T10:06:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-21T17:29:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"272118737156542257068941243857051666693","date":"2024-06-13T23:05:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-09T10:01:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-09T09:55:14+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-06-08T15:40:37+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-06T09:49:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-05-14T17:50:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a201ec2a-5857-4b6f-bc2c-2d413c449fdc","owner":[],"postedDate":"June 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":33258595,"name":"Health sciences/Cardiology"},{"id":33258596,"name":"Health sciences/Health care"}],"tags":[],"updatedAt":"2025-02-10T16:07:14+00:00","versionOfRecord":{"articleIdentity":"rs-4420887","link":"https://doi.org/10.1038/s41598-025-87179-1","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-02-08 15:57:23","publishedOnDateReadable":"February 8th, 2025"},"versionCreatedAt":"2024-06-20 15:19:54","video":"","vorDoi":"10.1038/s41598-025-87179-1","vorDoiUrl":"https://doi.org/10.1038/s41598-025-87179-1","workflowStages":[]},"version":"v1","identity":"rs-4420887","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4420887","identity":"rs-4420887","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}