Siddharth A. Wayangankar
Confirming a previous presentation, patients who had a delayed discharge after transcatheter aortic valve replacement had a significantly increased risk for mortality after adjustment for in-hospital complications, according to a study published in JACC: Cardiovascular Interventions.
Data from this study were previously presented at the Society for Cardiovascular Angiography and Interventions Scientific Sessions in 2018 and reported on by Cardiology Today’s Intervention.
“We were able to analyze 4 years’ worth of data, beginning when the registry was established in 2011, up to 2015,” Siddharth A. Wayangankar, MD, interventional cardiologist and researcher at the University of Florida in Gainesville and a Cardiology Today Next Gen Innovator, said in a press release. “Through this work, we discovered that rates of delayed discharge have declined during this time.”
STS/ACC registry data
Researchers analyzed data from 24,285 patients from the Society of Thoracic Surgery/American College of Cardiology Transcatheter Valve Therapy Registry who underwent transfemoral TAVR between November 2011 and September 2015.
Patients were categorized based on their hospital length of stay as early discharge ( 72 hours; n = 13,389; age 85 years, 39%; 43% women) or delayed discharge ( 72 hours; n = 10,896; age 85 years, 42%; 46% women).
Outcomes of interest at 1 year were time to event occurrence of MI, all-cause mortality and stroke. The composite endpoint was defined as a composite of MACE, including MI, all-cause mortality, major bleeding or stroke.
The rates of delayed discharge declined from 2011 to 2015 (62% to 34%; P < .01), which remained unchanged after stratifying by Transcatheter Valve Therapy risk scores.
Predictors of discharge, mortality
Several independent predictors of early and delayed discharged were identified, such as being Hispanic, being African-American, being older than 85 years, presence of diabetes, previous mitral valve procedures, experiencing atrial fibrillation and having NYHA functional class IV.
A predictor of all-cause mortality at 1 year was delayed discharge even after adjusting for in-hospital complications (HR = 1.45; 95% CI, 1.3-1.6).
“Development of preprocedural and postprocedural risk scores would help in proper patient selection and more importantly post-procedurally help in planning closer follow-up and more rigorous risk factor modification in the delayed discharge to mitigate the risk of higher mortality,” Wayangankar and colleagues wrote.
“I am confident that the ‘minimalistic TAVR’ will be adopted more frequently in the future, and this is the right path to walk,” Marco Barbanti, MD, research associate at the University of Catania in Italy, wrote in a related editorial. “However, I firmly believe that ‘timely’ discharge, rather than ‘early’ discharge, should be the main objective of our practice. As physicians and academics, we have the duty to ensure that the pursuit of a minimalist approach in TAVR does not take the drift of a simplistic strategy that could compromise the quality and the effectiveness of our care.” – by Darlene Dobkowski
Disclosures: Wayangankar reports he is a proctor for Medtronic Valve therapies. Barbanti reports he is a consultant for Edwards Lifesciences and is an advisory board member for Biotronik. The other authors report no relevant financial disclosures.