Urgent TAVI patients more likely to be readmitted than elective cases

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Readmissions within 30 days are more common following urgent, rather than elective, transcatheter aortic valve implantation (TAVI) procedures, a retrospective cohort analysis of the US Nationwide Readmission Database (NRD), published in Catheterization and Cardiovascular Interventions, has concluded.

The analysis by Birendra Amgai (Interfaith Medical Center, New York, USA) and colleagues sought to identify the rate of 30-day all-cause readmission, common causes of readmission, and distribution of morbidity in index admission and readmission after urgent and elective TAVI. The study team performed a retrospective cohort study using the Nationwide Readmission Database (NRD) data for 2016.

“TAVI has become an attractive, safe, and effective alternative to surgical aortic valve replacement (SAVR) or medical therapy in patients with severe symptomatic aortic stenosi,” Amgai and colleagues note in their introduction to the study. Interestingly, 20% of hospital admissions for aortic stenosis are for acute decompression. The authors have highlighted that most TAVI performed in the USA is done electively in hemodynamically stable patients. Using International Classification of Diseases, Tenth Revision codes (02R.F38H, 02R.F38Z, 02R.F48Z) to identify all TAVI procedures carried out in patients >18 years old; the study team identified 8,379 patients who underwent urgent TAVI, as well as 32,006 patients who underwent elective TAVI in 2016.

Amgai and colleagues report that the mean age of patients undergoing urgent TAVI was 79±9.97 years with 44.6% women, while the mean age of patients undergoing elective TAVI was 80.7±8.25 years with 46.2% women. In addition, they found that the 30-day all-cause readmission rate was 15.5% and 9.5% in patients undergoing urgent and elective TAVI, respectively (p<0.001). The cardiac cause was the predominant cause of readmission in both groups (43.77% vs. 42.11%, p=0.57), followed by pulmonary cause, gastrointestinal (GI) cause, and renal cause. Among cardiac causes, congestive heart failure (CHF) was the predominant cause of readmission and was similar in both groups (18.73 in urgent TAVR vs. 15.73 in elective TAVR, p=0.12), the study’s authors add.

Considering the relevance of their findings, Amgai et al note that data from the Society of Thoracic Surgeons/American College of Cardiology (STS/ACC) Transcatheter Valve Therapy (TVT) registry from November 2011 to June 2013 reported a 30-day readmission rate of 17.4% among 12,122 Medicare patients. “Although the patients undergoing urgent TAVI are the sickest population with multiple comorbidities, the comparable readmission rate seen in our study was encouraging, and it is likely because of the newer generation of valves and devices,” Dhrubajyoti Bandyopadhyay (Mount Sinai St Luke’s Roosevelt Hospital, New York, USA), one of the co-authors suggested.

Implementing critical interventions such as arranging early follow-up appointments after discharge or having a process in place to send all discharge paper or electronic summaries directly to the patient’s primary physician may be effective strategies to reduce readmission rates, the authors added. In addition, another author, Adrija Hajra from Albert Einstein College of Medicine/Jacobi Medical Center, New York, USA mentioned that identifying the predictors of 30-day readmission of urgent and elective TAVI can be helpful in the implementation of strategies to decrease the readmissions.


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