OA4-AM24-MN-39 - Transfusion-Associated Circulatory Overload (TACO) Among Inpatient U.S. Medicare Beneficiaries Ages 65 and Older,2016-2023:A Claims-based Study
Mikhail Menis, PharmD; MS Epi; MS PHSR: No financial relationships to disclose
Background/Case Studies: TACO is a leading cause of reported fatalities, presenting as respiratory distress with cardiogenic pulmonary edema. The objective was to assess TACO occurrence and potential risk factors among the inpatient U.S. Fee-for-Service Medicare beneficiaries ages 65 and older during 2016-2023.
Study
Design/Methods: This retrospective study utilized large Medicare databases for January 1, 2016-December 31, 2023. Transfusions were identified by recorded procedure and revenue center codes, and TACO by diagnosis codes. We evaluated the unadjusted TACO rates (per 100,000 inpatient transfusion stays): overall, pre- (2016-2019) and during COVID-19 pandemic (2020-2023), and by immunocompromised (IC) status, calendar year, transfusion, and recipient characteristics. We also assessed case-severity measures, including inpatient mortality, ICU/CCU admission, and length of stay (LOS). Fisher’s exact tests were performed to compare rates by characteristics evaluated, and Cochran-Armitage tests to ascertain trends by year, age, and units.
Results/Findings: Of 7,570,724 inpatient transfusion stays, 9,221 had a TACO diagnosis code, an overall rate of 121.8 per 100,000 stays, with 4-year pre- and pandemic rates of 115.7 and 129.7. Rates among females and males were 132.1 and 109.9 (p< 0.001); whites and non-whites: 127.4 and 95.1 (p< 0.001). For IC vs. non-IC, rates were 176.3 vs. 105.0 [rate ratio 1.7 (95% CI 1.6-1.8)]. The overall annual TACO rates ranged from 108.5 in 2016 to 152.2 in 2023 (p< 0.001), and for IC: from 155.5 to 230.7 (p< 0.001), and for non-IC: from 95.6 to 125.7 (p< 0.001). Rates by units increased from 61.5 for 1 unit to 293.3 for >9 units (p< 0.001). Rates by blood components were lowest for convalescent plasma only: 26.3, autologous transfusions: 42.8, plasma only: 61.3, platelets only: 81.6; and highest for RBCs only: 132.9, RBCs and plasma: 231.0, RBCs and platelets: 343.9, and RBCs, plasma, and platelets: 299.3. Rates by age group ranged from 96.6 for 65-69 to 149.1 for 85+ (p< 0.001). TACO cases had: ICU/CCU admissions (61.7%), LOS≥7 days (56.6%) and inpatient mortality (8.1%). Conclusions: Our 8-year population-based study shows significantly increasing TACO trends over time, overall and by IC status. The study identified higher TACO risk during vs. pre-pandemic. By components, the highest TACO risk was for RBCs, either alone or in combination, while the lowest risks were for convalescent plasma only and autologous transfusions. Findings show higher TACO diagnosis rates with greater number of units, advancing age, for IC vs. non-IC, females vs. males, and whites vs. non-whites. Further investigation is needed to assess risk factors for TACO occurrence during and pre-pandemic.
