Data from the multicentre FAST-TAVI trial indicate that early discharge—discharge within 72 hours—in an all-comers population undergoing transcatheter aortic valve implantation (TAVI) is safe and feasible. Furthermore, these data show that prespecified criteria can help to identify patients who have a low risk of poor outcomes after early discharge.
Presenting the data at PCR London Valves (9–11 September, London, UK), Marco Barbanti (Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy) reported that the primary endpoint of FAST-TAVI was the “determination of the incidence of all-cause mortality, stroke, permanent pacemaker implantation, major vascular complications, bleeding and re-hospitalisation at 30 days” among patients who had been discharged early vs. those who had been discharge late (72 hours after a TAVI procedure). He added that the secondary endpoint of the study was “to test prospectively a set of prespecified criteria for early discharge”. The “low-risk criteria”, according to Barbanti, included New York Heart Association (NYHA) Class ≤II, having no chest pain that could be attributed to cardiac ischaemia, and independent mobilisation and being “self-caring”.
Of 502 patients enrolled in the study, three died prior to the TAVI procedure. The average age was 81.4±6 years, 242 patients were female, and the average logistic EuroScore was 5±6. Overall, most patient were discharged alive (496 of 499) and most of these were discharged within 72 hours (306 patients; 72.6%). Of those who fulfilled the low-risk risk criteria (367 of those discharged alive), 72.2% were discharged early whereas only 27.8% of patients who did not fulfil these criteria were discharged early. For all patients, logistical factors were the major contributors to a late discharge after TAVI.
At 30 days, there were no significant differences between early discharge (360) and late discharge patients (136) patients in the rate of all-cause mortality, stroke/transient ischaemic attack, or the rate of re-hospitalisation. However, significantly more late discharge patients received a new permanent pacemaker (15% vs. 4.1% for early discharge patients; p<0.001), had major vascular complications (5.6% vs. 0.6%, respectively; p=0.014), and had life-threatening bleeding (11.1% vs. 8.9%; p=0.465).
Barbanti commented that the FAST-TAVI study was important because it was “the first and largest multicentre prospective study to investigate the feasibility and safety of timely discharge after transfemoral TAVI in an all-comers population”. “We demonstrated that timely discharge is feasible and safe in unselected an transfemoral TAVI population. The trial set a number of prespecified criteria that can help physicians to identify patients at low-risk for early discharge,” he added.
In a previous study, which was published in Heart, Barbanti and colleagues showed early discharge did not increase the risk of death in a selected population. In this retrospective study, the investigators found that—via a multivariate analysis—patients with baseline NYHA IV or any bleeding were less likely to be discharged early whereas those who underwent the procedure more recently or who had a permanent pacemaker (implanted prior to the TAVI procedure) were more likely to be discharged early.