525 Overnight Criteria Led Discharge for Intermediate Risk Chest Pain: A Review of Safety at a Tertiary Cardiac Referral Centre

Abstract

Introduction: The increasing implementation of transcatheter aortic valve implantation (TAVI) in various Australian centres warrants real-world data on the prevalence and outcomes of these patients. Methods: From the Centre-of-Health-Record-Linkage registry, all New South Wales residents who underwent TAVI in public and private facilities between 5-June,2013 and 30-June,2018 were identified. Public centres with an average TAVI caseload ,20 per-annum were classified as low-volume facilities. Private centres did not have individual facility identifier available and were classified as one category. Allcause mortality was tracked from the statewide death registry. Results: The study cohort comprised 1098 persons (mean [6SD] age: 83.367.7yrs; 58.8% males). 37.1% (407/1098 cases) were performed in public centres, and 53.3% (217/407 cases) of these were performed in low-volume centres. 62.9% (691/1098 cases) were performed in private centres. Proportion of cases performed in the public sector reduced from 83.3% in 2013 to 33.1% by 2017. In-hospital, 30-days and 180days all-cause mortality rates were 1.28%, 2.0% and 4.92% respectively. TAVI performed in low-volume compared to private or high-volume public centres was an independent predictor for all-cause mortality at 180-days (adjusted hazard ratio 3.49, 95% confidence interval 1.39-8.78, p=0.01). Conclusion: TAVI procedures are increasing, with a greater proportion of cases now performed in private centres. High-volume caseload may be an important determinant of patient outcomes.