Rajkumar Doshi1, Sailaja Pisipati2, Mohamed Taha2, Mihir Dave3, Jay Shah4, Devina Adalja5, Nageshwara Gullapalli2. 1. Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV 89502, United States. Electronic address: rdoshi@med.unr.edu. 2. Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV 89502, United States. 3. Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV 89502, United States; Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States. 4. Department of Internal Medicine, Mercy St. Vincent Medical Center, Toledo, OH, USA. 5. Department of General Medicine, Gotri Medical Education and Research Center, Vadodara, Gujarat, India.
Abstract
INTRODUCTION: New onset Atrial Fibrillation (NOAF) is frequently seen post transcatheter aortic valve replacement (TAVR). NOAF in the setting of TAVR has also been recognized as predictor of worse outcomes, including higher readmission rates. Data assessing the effect and predictors of NOAF on 30-day readmission rates post TAVR is limited. OBJECTIVE: To assess the incidence, 30-day readmission rate and predictors of NOAF in patients who underwent TAVR. METHODS: Nationwide Readmissions Database was used to identify patients who developed NOAF post-TAVR between 2012 and 2015. RESULTS: A total of 24,076 patients were included in this study, of which 54% were males, and the mean age was 82.4 ± 7.2. NOAF was developed in 10,847 (45%) patients. Overall readmission rates with NOAF was 19.7% and trend in the readmissions reduced during the course of the study (21.9% to 18.7%, Ptrend < 0.001). Thirty-day readmission rate in patients who developed NOAF post-TAVR was significantly higher compared to TAVR patients without NOAF (OR 1.39; 95% CI, 1.28-1.51; p < 0.001). Similarly, rate of ischemic stroke was significantly higher among patients who developed NOAF (OR 1.22; 95% CI, 1.07-1.4; p = 0.004). Predictors of readmissions in NOAF group were mostly non-cardiac, and included age, and comorbidities with chronic liver disease, renal failure and chronic lung disease been the most common comorbidities, in that order. CONCLUSIONS: Incidence of NOAF is associated with increased risk of readmissions and ischemic stroke. Future research should focus on interventions to prevent avoidable readmissions and associated morbidity and mortality.
INTRODUCTION: New onset Atrial Fibrillation (NOAF) is frequently seen post transcatheter aortic valve replacement (TAVR). NOAF in the setting of TAVR has also been recognized as predictor of worse outcomes, including higher readmission rates. Data assessing the effect and predictors of NOAF on 30-day readmission rates post TAVR is limited. OBJECTIVE: To assess the incidence, 30-day readmission rate and predictors of NOAF in patients who underwent TAVR. METHODS: Nationwide Readmissions Database was used to identify patients who developed NOAF post-TAVR between 2012 and 2015. RESULTS: A total of 24,076 patients were included in this study, of which 54% were males, and the mean age was 82.4 ± 7.2. NOAF was developed in 10,847 (45%) patients. Overall readmission rates with NOAF was 19.7% and trend in the readmissions reduced during the course of the study (21.9% to 18.7%, Ptrend < 0.001). Thirty-day readmission rate in patients who developed NOAF post-TAVR was significantly higher compared to TAVR patients without NOAF (OR 1.39; 95% CI, 1.28-1.51; p < 0.001). Similarly, rate of ischemic stroke was significantly higher among patients who developed NOAF (OR 1.22; 95% CI, 1.07-1.4; p = 0.004). Predictors of readmissions in NOAF group were mostly non-cardiac, and included age, and comorbidities with chronic liver disease, renal failure and chronic lung disease been the most common comorbidities, in that order. CONCLUSIONS: Incidence of NOAF is associated with increased risk of readmissions and ischemic stroke. Future research should focus on interventions to prevent avoidable readmissions and associated morbidity and mortality.
Authors: George Cholack; Joshua Garfein; Rachel Krallman; Delaney Feldeisen; Daniel Montgomery; Eva Kline-Rogers; Geoffrey D Barnes; Kim Eagle; Melvyn Rubenfire; Sherry Bumpus Journal: Int J Med Stud Date: 2022 Jan-Mar