Structural Heart Consortium’s efforts cut transfusions by 80% and improved TAVR outcomes

The Michigan Structural Heart Consortium* is a quality improvement project designed to enhance quality of care and patient outcomes in Michigan for those who undergo transcatheter valve procedures. Specifically, MISHC reports data on transcatheter aortic valve replacement, transcatheter mitral valve replacement and transcatheter edge-to-edge repair. Over 130 cardiologists and heart surgeons from 30 hospitals across Michigan collaborate in MISHC, collecting data on over 2500 procedures annually and impacting this $140M annual specialty in Michigan.

Periprocedural bleeding and anemia are common among TAVR patients, and blood transfusion is often administered to mitigate these effects. However, transfusion is independently associated with worse outcomes for patients, which can include death.

MISCH began examining trends in transfusion starting with 2014 data and recognized an important opportunity to improve the quality of care and outcomes for patients undergoing TAVR. Over the next few years, they began tracking and reporting transfusion rates to participating sites in data reports. Ultimately, this set consortium-wide transfusion reductions goals and facilitated issue discussion at consortium meetings with treating physicians and other TAVR team members.

Despite seeing a steady decline in transfusion rates among TAVR patients, MISHC knew there was still room for improvement and that every transfusion avoided would be better for patients. Since 2019, they decreased their target further and issued two new best practice protocols aimed at quality improvement on this measure: vascular access management and best practices for transfusion management.

These efforts have contributed to an 80% decrease in transfusions over the last eight years in Michigan, leading to over 2,000 transfusions avoided. Additionally, hospitals in Michigan consistently outperform national rates of transfusion year over year. These statistics underscore the value of Collaborative Quality Improvement organizations in Michigan and their impact on improving patient outcomes.

*MISHC is a collaboration between the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative and the BMC2 Cardiovascular Consortium.

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.