This retrospective cohort study used medical and long-term care (LTC) insurance claims from 13 Japanese municipalities. It covered 1,361 patients aged 75 or over who had transcatheter aortic valve implantation (TAVI). Patients were grouped by baseline certified care needs, from Independent (n = 725) to LTC Level 3-5 (n = 107). Of 532 patients followed for 36 months, 53% were independent at baseline; about half of these remained independent. At 36 months, monthly medical and LTC costs were about five times higher in LTC Level 3-5 than Independent. LTC Level 3-5 had higher all-cause mortality (HR 3.19, 95% CI 2.18-4.67), though a retrospective design shows associations only.
Why it is interesting: Certified care needs level before TAVI separated patients aged 75 or over into groups with very different costs and survival. These levels come from routine LTC insurance certification, not from a separate clinical assessment.
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