Original Title: Traitement de l’insuffisance mitrale par un dispositif percutané avec clip (TEER) au Québec

Authors' objectives: MSSS (the ministère de la Santé et des Services sociaux) has mandated INESSS (the Institut national d’excellence en santé et en services sociaux) to provide a portrait of the use of TEER for the treatment of MI in Québec, including the persons selected for TEER, the care processes associated with the intervention, clinical outcomes and the economic issues involved. The results of this evaluation will be used to inform and guide decisions to optimize the management and treatment of MI in Québec.

Authors' results and conclusions: RESULTS (#1 A STEADY INCREASE IN TEER VOLUME): A total of 319 TEERs were performed in the period from 2019–2020 to 2021– 2022 at the four designated centres in Québec. In addition, 185 persons were referred to the procedure but refused by an interdisciplinary committee; 12 persons were accepted for TEER but did not receive the intervention. • A 189% increase in TEER volume was observed from 2015–2016 (n = 45) to 2021–2022 (n = 130). However, two centres did not reach the minimum of two procedures per month recommended by INESSS. (#2 ORGANIZATION OF CARE AND SERVICES): The organization of care at the four designated centres is consistent with that of other Canadian and international healthcare systems, as well as with the recommendations of clinical practice guidelines This consistency is noted in terms of: • human resources (e.g., presence of an interdisciplinary committee to select patients eligible for TEER and types of professionals involved); • material resources (e.g., hemodynamics room or hybrid room, type and number of clips per procedure); • care pathways (e.g., where patients come from, duration of the procedure, length of hospital stay). (#3 CLINICAL PROFILE): The profile of TEER recipients in Québec is comparable to international data • The clientele is elderly (median age 78), more often male (69%) and slightly overweight (median BMI 26). Moreover, 72% of the clientele have limited functional capacity (NYHA grades III or IV). • Few recipients have a mixed etiology. In fact, 49% have secondary MI and 45% have primary MI. Recipients with secondary MI have more cardiovascular antecedents and risk factors than those with primary MI. (#4 CLINICAL OUTCOMES-THE PERCENTAGE OF SUCCESSFUL PROCEDURES IS HIGH, WITH AN IMPROVEMENT IN PRACTICES OVER THE THREE YEARS OF DATA COLLECTION): A consensus on the definition of procedural success was reached by the advisory committee. Technical success of the procedure is achieved when the severity of post-procedure regurgitation is moderate or less. (#5 MORTALITY AND REHOSPITALIZATIONS-THE PERCENTAGE OF REHOSPITALIZATIONS, ALL CAUSES COMBINED, DECREASES FROM 2019–2020 TO 2021–2022): 11.6% of recipients (alive at discharge from index hospitalization) had at least one readmission at 30 days, all causes combined. (#6 ECONOMIC CONSIDERATIONS): According to the studies identified, although TEER does not generate a financial gain for healthcare systems when compared with drug therapy alone, TEER is cost-efficient with respect to a defined threshold of ability to pay (for Canada, USA, France, Japan, Italy, UK), except in Germany where its efficiency could not be demonstrated. However, this result is not very transferable to Québec, since the ability-to-pay threshold is specific to each region. CONCLUSION: Québec practice complies with local and international recommendations concerning the organization of care surrounding TEER. However, certain areas for improvement have been identified, notably: 1) long waiting times between referral for TEER and the date of the procedure; and 2) the fact that some centres do not meet the expected minimum of two procedures per month.

Authors' methods: Data collection was carried out by reviewing the medical records of 516 adults who received a TEER or were evaluated by an interdisciplinary committee, from 2019–2020 to 2021–2022, at the four designated centres in Québec (the Centre hospitalier de l'Université de Montréal [CHUM], the McGill University Health Centre [MUHC], the Institut de cardiologie de Montréal [ICM] and the Institut universitaire de cardiologie et de pneumologie de Québec [IUCPQ]). Data from MED-ÉCHO and K29 death records were also matched to identify rehospitalizations up to one-year post-discharge and deaths up to one-year post-procedure. Where possible, volumetric data were compared with previous INESSS publications. A rapid review of the grey and scientific literature was also conducted to identify relevant information on: 1) different models of care and service organization for TEER; 2) clinical outcomes related to the practice of TEER internationally in the context of clinical care (results from international registries); 3) clinical factors associated with risks of death and rehospitalization following TEER; and 4) economic studies on TEER. Finally, a multidisciplinary advisory committee of various healthcare professionals was called upon to contextualize TEER as part of clinical practice in Québec.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/traitement-de-linsuffisance-mitrale-par-un-dispositif-percutane-avec-clip-teer-entre-2019-2020-et-2021-2022-au-quebec.html

Year Published: 2025

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/traitement-de-linsuffisance-mitrale-par-un-dispositif-percutane-avec-clip-teer-entre-2019-2020-et-2021-2022-au-quebec.html

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)