Identifying patients likely to be readmitted after transcatheter aortic valve replacement

Abstract

Hospital readmission following transcatheter aortic valve replacement (TAVR) contributes considerably to the costs of care. Readmission rates following TAVR have been reported to be as high as 17.4% at 30 days and 53.2% at 1 year. Patient and procedural factors predict an increased likelihood of readmission including non-transfemoral access, acute and chronic kidney impairment, chronic lung disease, left ventricular systolic dysfunction, atrial fibrillation, major bleeding and prolonged index hospitalisation. Recent studies have also found the requirement for new pacemaker implantation and the severity of paravalvular aortic regurgitation and tricuspid regurgitation to be novel predictors of readmission. Post-TAVR readmission within 30 days of discharge is more likely to occur for non-cardiac than cardiac pathology, although readmission for cardiac causes, especially heart failure, predicts higher mortality than readmission for non-cardiac causes. To combat the risk of readmission and associated mortality, the routine practice of calculating and considering readmission risk should be adopted by the heart team. Furthermore, because most readmissions following TAVR occur for non-cardiac reasons, more holistic approaches to readmission prevention are necessary. Familiarity with the most common predictors and causes of readmission should guide the development of initiatives to address these conditions proactively.

Risk Factors for Hospital Readmission Post-Transcatheter Aortic Valve Implantation in the Contemporary Era: A Systematic Review

“…Similar work in this area has been done by Goldsweig et al. (2020) 21 and Li et al. (2021) 22 Goldsweig et al.…”

“…The ability to stratify patients according to readmission risk is necessary because initiatives aimed at lowering rehospitalization rates may be more successful when targeted toward those patients who are most at risk. 20 Similar work in this area has been done by Goldsweig et al (2020) 21 and Li et al (2021) 22 Goldsweig et al 21 conducted a rapid review to identify predictors for post-TAVI readmission. They reported on 10 studies and 24 unique predictors.…”

“…(2021) 22 Goldsweig et al. 21 conducted a rapid review to identify predictors for post-TAVI readmission. They reported on 10 studies and 24 unique predictors.…”

Female showed favorable left ventricle hypertrophy regression during post‐TAVR follow‐up

“…Lastly, early and late rehospital readmissions that affect post-TAVR mortality were not recorded in this study. 28,29 Our study suggests that sex-related differences exist after TAVR by measuring echocardiographic parameters. Women had better LVEF and LVMI than men.…”

Impact of early hospital discharge on clinical outcomes after transcatheter aortic valve implantation

“…In a study by Kamioka et al, 28 next‐day discharge showed similar 30‐day and better 1‐year clinical outcomes when compared to those with longer hospital stay, indicating patient safety as the number one advantage. In order to reach this goal, thorough pre‐procedural work‐up and information to the patient prepares for an early discharge 27 as well as taking the frailty and comorbidities of the patient into consideration 29 …”