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Discharge Location and Outcomes After Transcatheter Aortic Valve Implantation


Sweda, Romy; Dobner, Stephan; Heg, Dik; Lanz, Jonas; Malebranche, Daniel; Langhammer, Bettina; Okuno, Taishi; Praz, Fabien; Räber, Lorenz; Valgimigli, Marco; Reineke, David; Pilgrim, Thomas; Windecker, Stephan; Stortecky, Stefan (2021). Discharge Location and Outcomes After Transcatheter Aortic Valve Implantation. American Journal of Cardiology, 140:95-102.

Abstract

The relation between discharge location and outcomes after transcatheter aortic valve implantation (TAVI) is largely unknown. Thus, the objective of this study was to investigate the impact of discharge location on clinical outcomes after TAVI. Between August 2007 and December 2018, consecutive patients who underwent transfemoral TAVI at Bern University Hospital were grouped according to discharge location. Clinical adverse events were adjudicated according to VARC-2 end point definitions. Of 1,902 eligible patients, 520 (27.3%) were discharged home, 945 (49.7%) were discharged to a rehabilitation clinic and 437 (23.0%) were transferred to another institution. Compared with patients discharged to a rehabilitation facility or another institution, patients discharged home were younger (80.8 ± 6.5 vs 82.9 ± 5.4 and 82.8 ± 6.4 years), less likely female (37.3% vs 59.7% and 54.2%), and at lower risk according to STS-PROM (4.5 ± 3.0% vs 5.5 ± 3.8% and 6.6 ± 4.4%). At 1 year follow-up, patients discharged home had similar rates of all-cause mortality (HR adj 0.82; 95% CI 0.54 to 1.24), cerebrovascular events (HR adj 1.04; 95% CI 0.52 to 2.08) and bleeding complications (HR adj 0.93; 95% CI 0.61 to 1.41) compared with patients discharged to a rehabilitation facility. Patients discharged home or to rehabilitation were at lower risk for death (HR adj 0.37; 95% CI 0.24 to 0.56 and HR adj 0.44; 95% CI 0.32 to 0.60) and bleeding (HR adj 0.48; 95% CI 0.30 to 0.76 and HR adj 0.66; 95% CI 0.45 to 0.96) during the first year after hospital discharge compared with patients transferred to another institution. In conclusion, discharge location is associated with outcomes after TAVI with patients discharged home or to a rehabilitation facility having better clinical outcomes than patients transferred to another institution.

Abstract

The relation between discharge location and outcomes after transcatheter aortic valve implantation (TAVI) is largely unknown. Thus, the objective of this study was to investigate the impact of discharge location on clinical outcomes after TAVI. Between August 2007 and December 2018, consecutive patients who underwent transfemoral TAVI at Bern University Hospital were grouped according to discharge location. Clinical adverse events were adjudicated according to VARC-2 end point definitions. Of 1,902 eligible patients, 520 (27.3%) were discharged home, 945 (49.7%) were discharged to a rehabilitation clinic and 437 (23.0%) were transferred to another institution. Compared with patients discharged to a rehabilitation facility or another institution, patients discharged home were younger (80.8 ± 6.5 vs 82.9 ± 5.4 and 82.8 ± 6.4 years), less likely female (37.3% vs 59.7% and 54.2%), and at lower risk according to STS-PROM (4.5 ± 3.0% vs 5.5 ± 3.8% and 6.6 ± 4.4%). At 1 year follow-up, patients discharged home had similar rates of all-cause mortality (HR adj 0.82; 95% CI 0.54 to 1.24), cerebrovascular events (HR adj 1.04; 95% CI 0.52 to 2.08) and bleeding complications (HR adj 0.93; 95% CI 0.61 to 1.41) compared with patients discharged to a rehabilitation facility. Patients discharged home or to rehabilitation were at lower risk for death (HR adj 0.37; 95% CI 0.24 to 0.56 and HR adj 0.44; 95% CI 0.32 to 0.60) and bleeding (HR adj 0.48; 95% CI 0.30 to 0.76 and HR adj 0.66; 95% CI 0.45 to 0.96) during the first year after hospital discharge compared with patients transferred to another institution. In conclusion, discharge location is associated with outcomes after TAVI with patients discharged home or to a rehabilitation facility having better clinical outcomes than patients transferred to another institution.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Cardiocentro Ticino
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:1 February 2021
Deposited On:20 Nov 2020 12:17
Last Modified:08 Jan 2021 02:08
Publisher:Elsevier
ISSN:0002-9149
OA Status:Closed
Publisher DOI:https://doi.org/10.1016/j.amjcard.2020.10.058
PubMed ID:33144166

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