Comparison of Sex-Based Differences in Home or Nonhome Discharge Utilization of Rehabilitative Services and Outcomes Following Transcatheter Aortic Valve Implantation in the United States

Shah, Rohan; Hirji, Sameer; Jolissaint, Joshua S.; Lander, Heather; Shah, Pinak; Pelletier, Marc; Sobieszczyk, Piotr; Berry, Natalia; Nyman, Charles; Bhatt, Deepak L.; Body, Simon C.; Kaneko, Tsuyoshi

doi:10.1016/j.amjcard.2019.03.008

Cited by 8 publications

(9 citation statements)

References 18 publications

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“…Another important observation in our study, is that women had higher rate of nonhome discharge compared with men (11.3% vs 6.9%, p < .01). These findings concur with other studies, which showed that female sex has high association with nonhome discharge after TAVR and cardiac surgeries 25,26 …”

Section: Discussionsupporting

confidence: 93%

Sex‐stratified analysis of the safety of percutaneous left atrial appendage occlusion

Patel

Munir

Kawsara

et al. 2020

Cathet Cardio Intervent

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Objectives and Background There is insufficient current evidence about whether sex impacts outcomes of percutaneous left atrial appendage occlusion (LAAO). The aim of this study was to investigate the association between sex and short‐term outcomes of LAAO. Methods Patients who were hospitalized and underwent LAAO from October 2015 to December 2017 in the National Readmission Database were queried. The primary endpoint of interest was major in‐hospital adverse events. Secondary endpoints included, 30‐day readmission rate, nonhome discharge, and cost of hospitalization. Propensity score matching (1:1) was performed to compare the outcomes among women and men. Results A total of 9,281 patients were included in the current analysis [women = 3,659 (39%); men = 5,622 (61%)]. Comparing women to men, women had lower prevalence of diabetes mellitus (30.6% vs 35.7%, p < .01), heart failure (28.6% vs 30.8%, p = .03), vascular disease (55.5% vs 69.6%, p < .01) and renal failure (18.3% vs 21.2%, p < .01), and higher CHA2DS2VASc score (5 [IQR4‐6] vs 4 [IQR3‐6], p < .01). After propensity‐score matching, women had higher rate of major in‐hospital adverse events (2.8% vs 1.9%; p < .01), and nonhome discharges (11.4% vs 6.7%; p < .01). Additionally, 30‐day readmission rate was higher among women (10% vs 8.6%, p = .03). Conclusion Among hospitalized patients undergoing LAAO, women carry higher risk for major in‐hospital adverse events, nonhome discharge, and 30‐day readmission rates.

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Section: Discussionsupporting

confidence: 93%

Sex‐stratified analysis of the safety of percutaneous left atrial appendage occlusion

Patel

Munir

Kawsara

et al. 2020

Cathet Cardio Intervent

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“…Remarkably, females had a more than double likelihood for nonhome discharge (odds ratio, OR = 2.16). In a previous analysis using the National Inpatient Sample database, female sex was one of the major predictors of nonhome discharge after TAVR (OR on multivariable logistic regression = 2.17), despite the lower co‐morbidities . In the Women's INternational Transcatheter Aortic Valve Implantation (WIN‐TAVI) registry, a fourth of the women enrolled were not discharged home and this was associated with worse 1‐year outcome even after adjustment for baseline differences .…”

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confidence: 94%

“…The potential role of patientlevel factors that were not captured in the different databases cannot be ruled out, including for example social status. 4 In summary, nonhome discharge after TAVR is associated with a worse clinical outcome, prolonged hospitalization and increased hospital costs, whereas early discharge home seems feasible and safe in the vast majority of the elderly patients treated with TAVR. The logical conclusion is that we should establish care standards for TAVR patients aimed at minimizing postoperative care utilization to an "as needed" base.…”

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confidence: 97%

“…In general, women are more likely to undergo nonfemoral access, possibly because of smaller caliber of the ilio‐femoral axes. The potential role of patient‐level factors that were not captured in the different databases cannot be ruled out, including for example social status …”

mentioning

confidence: 99%

“…In a previous analysis using the National Inpatient Sample database, female sex was one of the major predictors of nonhome discharge after TAVR (OR on multivariable logistic regression = 2.17), despite the lower co-morbidities. 4 In the Women's INternational Transcatheter Aortic Valve Implantation (WIN-TAVI) registry, a fourth of the women enrolled were not discharged home and this was associated with worse 1-year outcome even after adjustment for baseline differences. 5 In general, women are more likely to undergo nonfemoral access, possibly because of smaller caliber of the ilio-femoral axes.…”

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confidence: 99%

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Bring the old boys—and girls—Back home

Saia

2019

Cathet Cardio Intervent

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Key Points What the article teaches. Patients who are not discharged home after transcatheter aortic valve replacement have higher mortality during follow‐up How it will impact practice. Implementation of hospital protocols aimed at reducing rates of un‐necessary nonhome discharge is desirable. What new research/study would help answer the question posed. The reasons for worse outcomes after nonhome discharge should be further investigated, as well as the cause of higher likelihood of nonhome discharge in some patients' subgroups, like women.

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