Siddharth A Wayangankar1, Islam Y Elgendy2, Qun Xiang3, Hani Jneid4, Sreekanth Vemulapalli3, Tigran Khachatryan5, Don Pham6, Anthony A Hilliard5, Samir R Kapadia7. 1. Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida. Electronic address: siddharth.wayangankar@medicine.ufl.edu. 2. Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida. 3. Duke Cardiovascular Research Institute, Durham, North Carolina. 4. Division of Cardiovascular Medicine, Baylor College of Medicine, Houston, Texas. 5. Division of Cardiovascular Medicine, Loma Linda University, Loma Linda, California. 6. Memorial Hermann Hospital, Houston, Texas. 7. Department of Cardiology, Cleveland Clinic, Cleveland, Ohio.
Abstract
OBJECTIVES: The goal of this study was to investigate the trends, predictors, and outcomes of delayed discharge (>72 h) after transcatheter aortic valve replacement. BACKGROUND: Length of stay post-transcatheter aortic valve replacement may have significant clinical and administrative implications. METHODS: Data from the Transcatheter Valve Therapy Registry were used to identify patients undergoing nonaborted transfemoral transcatheter aortic valve replacement who survived to discharge, and data linked from the Centers for Medicare & Medicaid Services were used to provide 1-year events. Patients were categorized to early discharge (≤72 h) versus delayed discharge (>72 h). The trends, predictors, and adjusted 1-year outcomes were compared in both groups. RESULTS: From 2011 to 2015, a total of 13,389 patients (55.1%) were discharged within 72 h, whereas 10,896 patients (44.9%) were discharged beyond 72 h. There was a significant decline in rates of delayed discharge across the study period (62% vs. 34%; p < 0.01). This remained unchanged when stratified by Transcatheter Valve Therapy risk scores. Several factors were identified as independent predictors of early and delayed discharge. After adjustment for in-hospital complications, delayed discharge was an independent predictor of 1-year all-cause mortality (hazard ratio: 1.45; 95% confidence interval: 1.30 to 1.60; p < 0.01). CONCLUSIONS: Rates of delayed discharge have declined from 2011 to 2015. Delayed discharge is associated with a significant increase in mortality even after adjusting for in-hospital complications. Further work is necessary to determine if predictors of early discharge could be used to develop length of stay scores that might be instrumental in administrative, financial, or clinical policy development.
OBJECTIVES: The goal of this study was to investigate the trends, predictors, and outcomes of delayed discharge (>72 h) after transcatheter aortic valve replacement. BACKGROUND: Length of stay post-transcatheter aortic valve replacement may have significant clinical and administrative implications. METHODS: Data from the Transcatheter Valve Therapy Registry were used to identify patients undergoing nonaborted transfemoral transcatheter aortic valve replacement who survived to discharge, and data linked from the Centers for Medicare & Medicaid Services were used to provide 1-year events. Patients were categorized to early discharge (≤72 h) versus delayed discharge (>72 h). The trends, predictors, and adjusted 1-year outcomes were compared in both groups. RESULTS: From 2011 to 2015, a total of 13,389 patients (55.1%) were discharged within 72 h, whereas 10,896 patients (44.9%) were discharged beyond 72 h. There was a significant decline in rates of delayed discharge across the study period (62% vs. 34%; p < 0.01). This remained unchanged when stratified by Transcatheter Valve Therapy risk scores. Several factors were identified as independent predictors of early and delayed discharge. After adjustment for in-hospital complications, delayed discharge was an independent predictor of 1-year all-cause mortality (hazard ratio: 1.45; 95% confidence interval: 1.30 to 1.60; p < 0.01). CONCLUSIONS: Rates of delayed discharge have declined from 2011 to 2015. Delayed discharge is associated with a significant increase in mortality even after adjusting for in-hospital complications. Further work is necessary to determine if predictors of early discharge could be used to develop length of stay scores that might be instrumental in administrative, financial, or clinical policy development.
Authors: Elizabeth M Perpetua; Kimberly A Guibone; Patricia A Keegan; Roseanne Palmer; Martina K Speight; Kornelija Jagnic; Joan Michaels; Rosemarie A Nguyen; Emily S Pickett; Dianna Ramsey; Susan J Schnell; Shing-Chiu Wong; Mark Reisman Journal: Struct Heart Date: 2022-03-21
Authors: Francesco Soriano; Claudio Montalto; Dario Calderone; Stefano Nava; Giuseppe Esposito; Francesco Saia; Jacopo A Oreglia; Lars Søndergaard Journal: Eur Heart J Case Rep Date: 2022-09-26
Authors: Amgad Mentias; Marwan Saad; Milind Y Desai; Phillip A Horwitz; James D Rossen; Sidakpal Panaich; Ayman Elbadawi; Abdul Qazi; Paul Sorajja; Hani Jneid; Samir Kapadia; Barry London; Mary S Vaughan Sarrazin Journal: J Am Heart Assoc Date: 2019-10-31 Impact factor: 5.501