1
|
Bække PS, Jørgensen TH, Thuraiaiyah J, Gröning M, De Backer O, Sondergaard L. Incidence, predictors, and prognostic impact of rehospitalization after transcatheter aortic valve implantation. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:446-455. [PMID: 37950564 DOI: 10.1093/ehjqcco/qcad067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/25/2023] [Accepted: 11/07/2023] [Indexed: 11/12/2023]
Abstract
AIMS Despite rehospitalization being common after transcatheter aortic valve implantation (TAVI), an in-depth analysis on this topic is missing. This study sought to report on the incidence, predictors, and prognostic impact of rehospitalization within 1 year following TAVI. METHODS AND RESULTS All consecutive patients treated with TAVI between 2016 and 2020 in East Denmark were included. Medical records of all patients were reviewed to validate rehospitalizations up to 1 year after discharge from the index admission. The study population consisted of 1397 patients, of whom 615 (44%) had an unplanned rehospitalization within the first year post-TAVI. The rehospitalization incidence rate was three-fold higher in the early period (within 30 days) compared with the late period (30 days to 1 year; 2.5 vs. 0.8 per patient-year, respectively; P < 0.001). Predictors of early unplanned rehospitalization were procedure-related complications and prior stroke, whereas late unplanned rehospitalization was associated with preexisting comorbidities. Predictors of heart failure (HF) rehospitalization included ischaemic heart disease, the extent of cardiac damage, atrial fibrillation, and New York Heart Association class at baseline. HF rehospitalization within 30 days and 1 year post-TAVI was associated with a markedly increased 1- and 5-year mortality risk [hazard ratio (HR) of 4.3 and 3.2 for 1-year mortality and HR of 3.2 and 2.9 for 5-year mortality, respectively; P< 0.001]. CONCLUSIONS Rehospitalization after TAVI is frequent in real-world practice. Early rehospitalization is mostly procedure related, whereas late rehospitalization is related to preexisting comorbidities. HF rehospitalization is associated with poor long-term survival and could be validated as a prognostically relevant endpoint for TAVI trials.
Collapse
Affiliation(s)
- Pernille Steen Bække
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100 Coppenhagen, Denmark
| | - Troels Højsgaard Jørgensen
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100 Coppenhagen, Denmark
| | - Jani Thuraiaiyah
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100 Coppenhagen, Denmark
| | - Mathis Gröning
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100 Coppenhagen, Denmark
| | - Ole De Backer
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100 Coppenhagen, Denmark
| | - Lars Sondergaard
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100 Coppenhagen, Denmark
| |
Collapse
|
2
|
Ali S, Thyagaturu H, Atti L, Byreddi LY, Roma N, Duhan S, Farooq F, Keisham B, Awad M, Santer M, Jagadeesan V, Kawsara A, Hamirani YS. Transcatheter aortic valve implantation with and without mitral stenosis - A National Readmission Database study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 65:1-7. [PMID: 38548532 DOI: 10.1016/j.carrev.2024.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/07/2024] [Accepted: 03/18/2024] [Indexed: 07/19/2024]
Abstract
INTRODUCTION Mitral valve stenosis (MS) can be concomitantly present in patients undergoing Transcatheter Aortic Valve Implantation (TAVI). Some studies have reported up to one-fifth of patients who underwent TAVI also have MS. The relationship between mitral stenosis and TAVI has led to concerns regarding increased adverse cardiac outcomes during and after the procedure. METHODS The Nationwide Readmission Database (NRD 2016-2019) was utilized to identify TAVI patients with MS with ICD-10-CM codes. The primary outcome was a 30-day readmission rate. Secondary outcomes included predictors of all-cause readmissions, length of stay, and total hospitalization cost. We assessed readmission frequency with a national sample weighed at 30 days following the index TAVI procedure. Unadjusted and adjusted odds ratios were analyzed for in-hospital outcomes using univariate and multivariate logistic regression for study cohorts. RESULTS A total of 217,147 patients underwent TAVI procedures during the queried time period of the study. Of these patients, 2140 (0.98 %) had MS. The overall 30-day all-cause readmission rate for the study cohort was 12.4 %. TAVI patients with MS had higher rates of 30-day readmissions (15.8 % vs 12.3 %, aOR 1.22, CI: 1.03-1.45, P < 0.01). Additionally, TAVI patients with MS had longer lengths of hospital stay during index admissions (5.7 vs. 4.3 days), along with higher total hospitalization costs ($55,157 vs. $50,239). In contrast, in-hospital mortality during index TAVI admission did not differ significantly between the two groups, although there was a trend toward higher mortality in the MS group (2.1 % vs. 1.5 %). Among the TAVI MS cohort, patients admitted on weekends (aOR: 1.11, 95 % CI: 1.02-1.22, P = 0.01), admitted to non-metropolitan hospitals (aOR: 1.29, 95 % CI: 1.11-1.66, P = 0.04) and presence of co-morbidities such as atrial fibrillation (AF)/flutter (aOR: 1.24, 95 % CI: 1.16-1.32, P < 0.01), chronic obstructive pulmonary disease (COPD) (aOR: 1.16, 95 % CI: 1.11-1.22, P < 0.01), prior stroke (aOR: 1.09, 95 % CI: 1.03-1.14, P < 0.01), chronic kidney disease (CKD) ≥3 (aOR: 1.16, 95 % CI: 1.11-1.22, P < 0.01), end-stage renal disease (ESRD) (aOR: 1.75, 95 % CI: 1.61-1.90, P < 0.01), and anemia (aOR: 1.23, 95 % CI: 1.18-1.28, P < 0.01) were associated with increased odds of readmission. CONCLUSION Concomitant MS in patients undergoing TAVI is associated with higher readmission rates and total hospital costs. This can contribute significantly to healthcare-related burdens. Further studies are required to evaluate in-hospital outcomes and predictors of readmission in patients undergoing TAVI with the presence of concomitant MS.
Collapse
Affiliation(s)
- Shafaqat Ali
- Department of Internal Medicine, Louisiana State University, Shreveport, LA, USA.
| | - Harshith Thyagaturu
- Department of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Lalitsiri Atti
- Department of Internal Medicine, Sparrow Hospital-Michigan State University, Lansing, MI, USA
| | | | - Nicholas Roma
- Department of Internal Medicine, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Sanchit Duhan
- Department of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Faryal Farooq
- Department of Internal Medicine, Allama Iqbal Medical College Lahore, Pakistan
| | - Bijeta Keisham
- Department of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Maan Awad
- Department of Internal Medicine, Allama Iqbal Medical College Lahore, Pakistan
| | - Matthew Santer
- Department of Medicine, West Virginia University, Morgantown, WV, USA
| | - Vikrant Jagadeesan
- Department of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Akram Kawsara
- Department of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Yasmin S Hamirani
- Department of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| |
Collapse
|
3
|
Butt JH, Yafasova A, Thein D, Begun X, Havers-Borgersen E, Bække PS, Smerup MH, De Backer O, Køber L, Fosbøl EL. Burden of hospitalization during the first year following transcatheter and surgical aortic valve replacement. Am Heart J 2024; 276:12-21. [PMID: 39084484 DOI: 10.1016/j.ahj.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/25/2024] [Accepted: 07/25/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Hospitalizations are a major burden for both patients and society but are potentially preventable. We examined the one-year hospitalization burden in patients undergoing transcatheter aortic valve replacement (TAVR) and compared hospitalization rates and patterns with those undergoing isolated surgical aortic valve replacement (SAVR). METHODS Using Danish nationwide registries, we identified patients who underwent first-time TAVR and isolated SAVR (2008-2019), respectively. Subsequent hospitalizations were classified as cardiovascular or noncardiovascular according to discharge diagnosis codes. RESULTS Patients undergoing TAVR (N = 4,921) were older and had more comorbidities than those undergoing SAVR (N = 5,220). There were 5,725 and 4,426 hospitalizations within the first year after discharge in the TAVR and SAVR group, respectively. During the one-year follow-up period post-TAVR, 46.6% were not admitted, 25.4% were admitted once, 12.6% twice, and 15.4% 3 times or more. The corresponding proportions in patients undergoing SAVR were 55.3%, 25.1%, 10.0%, and 9.5%, respectively. Among patients with ≥1 hospitalization following TAVR, 50.3% had a total length of all hospital stays between 1 and 7days, 19.0% 8-14days, 18.0% 15-30days, 9.9% 31-60days, and 2.8% ≥61days. The corresponding proportions for patients undergoing SAVR were 58.6%, 17.2%, 13.1%, 7.4%, and 3.7%, respectively. Compared with patients undergoing SAVR, those undergoing TAVR had a lower early (day0-30: HR 0.89 [95% CI, 0.80-0.98]), but a higher late hospitalization rate (day 31-365: 1.46 [1.32-1.60]). CONCLUSIONS The 1-year hospitalization burden following TAVR is substantial. Compared with patients undergoing isolated SAVR, those undergoing TAVR had a lower early, but a higher late hospitalization rate - a difference that likely reflects unmeasured differences in the patient cohorts.
Collapse
Affiliation(s)
- Jawad H Butt
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.
| | - Adelina Yafasova
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - David Thein
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Xenia Begun
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Eva Havers-Borgersen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Pernille S Bække
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten H Smerup
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole De Backer
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
4
|
Ogami T, Yousef S, Brown JA, Kliner DE, Toma C, Serna-Gallegos D, Doshi N, Wang Y, Sultan I. Readmission-related outcomes of surgical versus transcatheter aortic valve replacement in patients aged 65 or older with bicuspid aortic valve. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 63:16-20. [PMID: 38233251 DOI: 10.1016/j.carrev.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/20/2023] [Accepted: 01/10/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND There continues to be debate regarding the superiority of transcatheter (TAVR) over surgical aortic valve replacement (SAVR) in patients with bicuspid aortic valves (BAV). We aimed to compare outcomes during readmissions in elderly patients with BAV who underwent SAVR or TAVR. METHODS Patients 65 years or older with BAV who underwent TAVR or isolated SAVR were identified using the National Readmission Database from 2012 through 2018. We compared outcomes during readmissions within 90 days after discharge from the index surgery. Propensity score matching was performed to adjust the baseline differences. RESULTS During the study period, 8555 and 1081 elderly patients with BAV underwent SAVR and TAVR, respectively. The number of patients who underwent TAVR went up by 179 % from 2012 to 2018. Propensity score matching yielded 573 patients in each group. A total of 111 (19.4 %) in the SAVR group and 125 (21.8 %) in the TAVR group were readmitted within 90 days after the index surgery (p = .31). The mortality during the readmissions within 90 days was equivalent between the two groups (0.9 % in the SAVR group vs. 3.2 % in the TAVR group, p = .22). However, the median hospital cost was approximately doubled in the TAVR group during the readmission (18,250 dollars vs. 9310 dollars in the SAVR group, p < .001). CONCLUSIONS Readmission within 90 days was common in both groups. While the mortality during the readmissions after the surgery was equivalent between the two groups, hospital cost was significantly more expensive in the TAVR group.
Collapse
Affiliation(s)
- Takuya Ogami
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sarah Yousef
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - James A Brown
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dustin E Kliner
- Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Catalin Toma
- Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nandini Doshi
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yisi Wang
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| |
Collapse
|
5
|
Chau E, Mew A, Bera K, Jiang S, Ramaiya N, Gilkeson R. Emergency department imaging utilization post-transcatheter aortic valve replacement: single institution 7-year experience. Emerg Radiol 2024; 31:349-357. [PMID: 38649665 PMCID: PMC11130046 DOI: 10.1007/s10140-024-02228-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE This study aims to highlight presentations, acute findings and imaging phenotypes of patients presenting to the emergency department (ED) within 30 days of a transcatheter aortic valve replacement (TAVR). METHODS A retrospective review of patients diagnosed with aortic valve disease who underwent a TAVR between Jan 2015 and Nov 2021 at a large academic medical center was completed. From an initial 1271 patients, 146 were included based on their presentation to the ED within 30 days post-TAVR procedure. Patient data, including ED presentation details and imaging results, were recorded and de-identified. RESULTS Of the 146 post-TAVR patients, there were 168 ED visits within 30 days. The median time to ED after TAVR was 12 days. Respiratory symptoms were the most common complaint (27%). Neurological (23%) and cardiovascular symptoms (18%) followed. Cross-sectional imaging was conducted 250 times across visits, with an average of 1.7 scans per patient. CTs were most frequently used, followed by ultrasounds, especially echocardiograms and duplex extremity vasculature ultrasounds. 30.1% of patients had acute findings from imaging. Specific findings included heart failure (5.5%), access site complications (5.5%), pneumonia (5.5%), intracranial pathologies (3.4% for strokes and 0.7% for hematoma), and pleural effusion (3.4%). Echocardiograms and CTA chest were most associated with significant acute findings. CONCLUSION Our study highlights the vital role of early and accurate imaging in post-TAVR patients within 30 days post-procedure. As transcatheter approaches rise in popularity, emergency radiologists become instrumental in diagnosing common post-procedural presentations. Continued research is essential to devise post-discharge strategies to curtail readmissions and related costs. Proper imaging ensures prompt, effective care, enhancing overall patient outcomes.
Collapse
Affiliation(s)
- Eva Chau
- University of Pittsburgh School of Medicine, Pittsburgh, OH, USA
| | - Andy Mew
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kaustav Bera
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| | - Sirui Jiang
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Nikhil Ramaiya
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Robert Gilkeson
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| |
Collapse
|
6
|
Newell P, Javadikasgari H, Rojas-Alexandre M, Hirji S, Harloff M, Cherkasky O, McGurk S, Malarczyk A, Shah P, Sabe A, Kaneko T. All-cause procedural readmissions following transcatheter aortic valve replacement. JTCVS OPEN 2023; 15:83-93. [PMID: 37808066 PMCID: PMC10556937 DOI: 10.1016/j.xjon.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 04/12/2023] [Accepted: 05/01/2023] [Indexed: 10/10/2023]
Abstract
Objective With expanding eligibility criteria, transcatheter aortic valve replacement is being performed on patients with longer life expectancy, and subsequent procedures after index transcatheter aortic valve replacement are inevitable. This study examines the incidence and outcomes of patients undergoing subsequent procedural readmissions after transcatheter aortic valve replacement. Methods All patients who underwent index transcatheter aortic valve replacement and were discharged alive from January 2012 to December 2019 at a single institution were evaluated. Study end points were mortality and readmission for procedure with more than 1-day hospital stay. Effect on survival was evaluated by treating procedural readmission as a time-dependent variable by Cox proportional hazard model and competing risk analysis. Results A total of 1092 patients met inclusion criteria with a median follow-up time of 34 months. A total of 218 patients (20.0%) had 244 subsequent procedural readmissions. During the 244 procedural readmissions, there were 260 procedures; 96 (36.9%) were cardiac (most commonly pacemaker implantation, percutaneous coronary interventions, and surgical aortic valve replacements), and 164 (63.1%) were noncardiac (most commonly orthopedic and gastrointestinal procedures). The overall procedural readmission rates were 32%, 39%, and 42%, and all-cause mortality was 27%, 44%, and 54% at 20, 40, and 60 months, respectively. Procedural readmissions were not associated with a survival penalty in any surgical risk group or on Cox regression (hazard ratio, 1.25; 0.91-1.64, P = .17). Conclusions After transcatheter aortic valve replacement, procedural interventions are seen frequently, with most procedures occurring within the first year after transcatheter aortic valve replacement. However, subsequent procedural readmissions do not appear to have a survival penalty for patients after transcatheter aortic valve replacement. After transcatheter aortic valve replacement with resolution of aortic stenosis, subsequent procedures can and should be pursued if they are needed.
Collapse
Affiliation(s)
- Paige Newell
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Hoda Javadikasgari
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Mehida Rojas-Alexandre
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Sameer Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Morgan Harloff
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Olena Cherkasky
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Siobhan McGurk
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Alexandra Malarczyk
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Pinak Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Ashraf Sabe
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Washington University School of Medicine, St Louis, Mo
| |
Collapse
|
7
|
Zhou C, Xia Z, Song Y, Lian Z. Transcatheter versus surgical aortic valve replacement in patients with aortic regurgitation: A propensity-matched analysis. Heliyon 2023; 9:e16734. [PMID: 37303509 PMCID: PMC10248226 DOI: 10.1016/j.heliyon.2023.e16734] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 06/13/2023] Open
Abstract
This study aimed to analyze in-hospital and early-to-interim outcomes of pure aortic regurgitation (AR) using transcatheter aortic valve replacement (TAVR) vs. surgical aortic valve replacement (SAVR). Background Few studies have discussed and compared the safety and short-term prognosis of TAVR and SAVR in pure AR patients. As such, we looked to the National Readmissions Database (NRD) for records between 2016 and 2019 in order to identify patients diagnosed with pure AR who underwent SAVR or TAVR. We used the propensity score matching to minimize disparities between two groups. We included 23,276 pure AR patients: 1983 (8.5%) who underwent TAVR and 21,293 (91.5%) who underwent SAVR. We found 1820 matched pairs using propensity score matching. In the matching cohort, TAVR was associated with a low risk of in-hospital mortality. Although TAVR had lower incidences of 30-day all-cause readmission (hazard ratio (HR):0.73, 95% confidence interval (CI): 0.61-0.87; P < 0.01) and 6-month all-cause readmission (HR: 0.81, 95% CI: 0.67-0.97; P = 0.03), while TAVR had high incidences of 30-day permanent pacemaker implantation incidence (HR: 3.54, 95% CI: 1.62-7.74; P < 0.01) and 6-month permanent pacemaker implantation incidence (HR: 4.12, 95% CI: 1.17-14.4; P = 0.03).In conclusion, TAVR and SAVR had similar risks of hospital death and lower rates of 30-day and 6-month all-cause and cardiovascular readmission. But TAVR had a higher risk of permanent pacemaker implantation than SAVR in AR patients, suggesting that TAVR can be performed safely in pure AR patients.
Collapse
Affiliation(s)
| | | | | | - Zhexun Lian
- Corresponding author. No 16 Jiangsu Road, Shinan District, Qingdao, Shandong Province, China.
| |
Collapse
|
8
|
Pipes GM, Logue TC, Wen T, Booker WA, D'Alton ME, Friedman AM. Postpartum stroke trends, risk factors, and associated adverse outcomes. Am J Obstet Gynecol MFM 2023; 5:100864. [PMID: 36791844 DOI: 10.1016/j.ajogmf.2023.100864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Management of postpartum stroke has been the focus of several quality improvement efforts in the past decade. However, there is little recent national trends data for postpartum stroke readmissions. OBJECTIVE This study aimed to determine trends, risk factors, and complications associated with postpartum stroke readmission. STUDY DESIGN The 2013 to 2019 Nationwide Readmissions Database was used to perform a retrospective cohort study that evaluated the risk for readmission for stroke within 60 days of delivery hospitalization discharge. Temporal trends in readmissions were analyzed using the National Cancer Institute's Joinpoint Regression Program to estimate the average annual percent change with 95% confidence intervals. Stratified trends were analyzed for hemorrhage stroke, ischemic stroke, and stroke readmissions at 1 to 10, 11 to 30, and 31 to 60 days after delivery discharge. Risk factors for stroke were analyzed using unadjusted and adjusted logistic regression models with odds ratios and 95% confidence intervals as measures of association. The risk for stroke complications, including mechanical ventilation, seizures, death, and a prolonged stay ≥14 days, was analyzed. RESULTS Of an estimated 21,754,603 delivery hospitalizations, 5006 were complicated by a 60-day postpartum readmission with a diagnosis of stroke. The average annual percent change for all stroke readmissions over the study period was not significant (average annual percent change, 0.1%; 95% confidence interval, -2.2% to 2.4%). When the trends in readmission for ischemic and hemorrhagic stroke were analyzed, the results were similar, as were the stratified analyses by readmission timing. Risk factors associated with increased odds included superimposed preeclampsia (odds ratio, 4.8; 95% confidence interval, 3.9-5.9), preeclampsia with severe features (odds ratio, 3.7; 95% confidence interval, 3.0-4.4), maternal cardiac disease (odds ratio, 3.0; 95% confidence interval, 2.5-3.7), chronic kidney disease (odds ratio, 5.0; 95% confidence interval, 3.4-7.5), and lupus (odds ratio, 7.0; 95% confidence interval, 4.9-10.2). Risk was retained in adjusted analyses. Common stroke-related complications included a prolonged hospital stay ≥14 days (12.1 per 1000 stroke-related readmissions), seizures (9.9 per 1000 stroke-related readmissions), and mechanical ventilation (6.6 per 1000 stroke-related readmissions). CONCLUSION This analysis of nationally representative data demonstrated no change in the rate of 60-day postpartum hospitalizations for stroke from 2013 to 2019. Further clinical research is indicated to optimize risk reduction for stroke after delivery hospitalization discharge.
Collapse
Affiliation(s)
- Grace M Pipes
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY (Ms Pipes and Drs Logue, Booker, D'Alton, and Friedman)
| | - Teresa C Logue
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY (Ms Pipes and Drs Logue, Booker, D'Alton, and Friedman)
| | - Timothy Wen
- and Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, San Francisco, CA (Dr Wen)
| | - Whitney A Booker
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY (Ms Pipes and Drs Logue, Booker, D'Alton, and Friedman)
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY (Ms Pipes and Drs Logue, Booker, D'Alton, and Friedman)
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY (Ms Pipes and Drs Logue, Booker, D'Alton, and Friedman).
| |
Collapse
|
9
|
Sulaiman S, Kawsara A, Mahayni AA, El Sabbagh A, Singh M, Crestanello J, Gulati R, Alkhouli M. Development and Validation of a Machine Learning Score for Readmissions After Transcatheter Aortic Valve Implantation. JACC. ADVANCES 2022; 1:100060. [PMID: 38938389 PMCID: PMC11198219 DOI: 10.1016/j.jacadv.2022.100060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 06/29/2024]
Abstract
Background Identifying predictors of readmissions after transcatheter aortic valve implantation (TAVI) is an important unmet need. Objectives We sought to explore the role of machine learning (ML) in predicting readmissions after TAVI. Methods We included patients who underwent TAVI between 2016 and 2019 in the Nationwide Readmission Database. A total of 917 candidate predictors representing all International Classification of Diseases, Tenth Revision, diagnosis and procedure codes were included. First, we used lasso regression to remove noninformative variables and rank informative ones. Next, we used an unsupervised ML model (K-means) to identify patterns/clusters in the data. Furthermore, we used Light Gradient Boosting Machine and Shapley Additive exPlanations to specify the impact of individual predictors. Finally, we built a parsimonious model to predict 30-day readmission. Results A total of 117,398 and 93,800 index TAVI hospitalizations were included in the 30- and 90-day analyses, respectively. Lasso regression identified 138 and 199 informative predictors for the 30- and 90-day readmission, respectively. Next, K-means recognized 2 distinct clusters: low risk and high risk. In the 30-day cohort, the readmission rate was 10.1% in the low risk group and 23.3% in the high risk group. In the 90-day cohort, the rates were 17.4% and 35.3%, respectively. The top predictors were the length of stay, frailty score, total discharge diagnoses, acute kidney injury, and Elixhauser score. These predictors were incorporated into a risk score (TAVI readmission score), which exhibited good performance in an external validation cohort (area under the curve 0.74 [0.7-0.78]). Conclusions ML methods can leverage widely available administrative databases to identify patients at risk for readmission after TAVI, which could inform and improve post-TAVI care.
Collapse
Affiliation(s)
- Samian Sulaiman
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Akram Kawsara
- Division of Cardiology, West Virginia University, Morgantown, West Virginia, USA
| | - Abdulah Amr Mahayni
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Abdullah El Sabbagh
- Department of Cardiovascular Disease, Mayo Clinic, Jacksonville, Florida, USA
| | - Mandeep Singh
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan Crestanello
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Rajiv Gulati
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
10
|
Trunk stabilising exercises promote sternal stability in patients after median sternotomy for heart valve surgery: a randomised trial. J Physiother 2022; 68:197-202. [PMID: 35753968 DOI: 10.1016/j.jphys.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 10/27/2021] [Accepted: 06/06/2022] [Indexed: 11/22/2022] Open
Abstract
QUESTION What is the effect of trunk stabilising exercises on sternal stability in women who have undergone heart valve surgery via median sternotomy? DESIGN Randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. PARTICIPANTS Thirty-six women aged 40 to 50 years who had undergone heart valve surgery via median sternotomy 7 days before enrolment. INTERVENTION All participants in both groups received cardiac rehabilitation during hospitalisation and three times per week for 4 weeks after discharge. In addition, participants in the experimental group were prescribed a regimen of trunk stabilising exercises to be performed three times per week for 4 weeks. At each exercise session, each of 11 exercises were to be performed with five to ten repetitions. OUTCOME MEASURES The primary outcome was sternal separation (the distance between the two halves of the bisected sternum). The secondary outcome was the Sternal Instability Scale from 0 (no instability) to 3 (an unstable sternum with substantial movement or separation). Measures were taken before and after the 4-week intervention period. RESULTS After the 4-week intervention period, the experimental group had a greater decrease in sternal separation by 0.09 cm (95% CI 0.07 to 0.11). The experimental group was twice as likely to improve by at least one grade on the Sternal Instability Scale by 4 weeks (RR 2.00, 95% CI 1.07 to 3.75). The experimental group was almost three times as likely to have a clinically stable sternum (grade 0 on the Sternal Instability Scale) by 4 weeks (RR 2.75, 95% CI 1.07 to 7.04). CONCLUSION Trunk stabilising exercises were an effective and feasible method of promoting sternal stability in women who underwent heart valve surgery via median sternotomy. TRIAL REGISTRATION NCT04632914.
Collapse
|
11
|
Gad MM, Elgendy IY, Saad AM, Mahmoud AN, Isogai T, Chahine J, Kadri AN, Ghanta R, Jimenez E, Kapadia SR, Jneid H. Outcomes of transcatheter versus surgical aortic valve replacement in patients <60 years of age. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 43:7-12. [DOI: 10.1016/j.carrev.2022.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 04/06/2022] [Accepted: 05/09/2022] [Indexed: 12/30/2022]
|
12
|
Emeruwa UN, Gyamfi-Bannerman C, Wen T, Booker W, Wright JD, Huang Y, D'Alton ME, Friedman AM. Adverse Outcomes during Postpartum Readmissions after Deliveries Complicated by Hypertensive Disorders of Pregnancy. Am J Perinatol 2022; 39:699-706. [PMID: 34768308 DOI: 10.1055/s-0041-1739429] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study aimed to characterize risk for postpartum complications based on specific hypertensive diagnosis at delivery. STUDY DESIGN This retrospective cohort study used the 2010 to 2014 Nationwide Readmissions Database to identify 60-day postpartum readmissions. Delivery hospitalizations were categorized based on hypertensive diagnoses as follows: (1) preeclampsia with severe features, (2) superimposed preeclampsia, (3) chronic hypertension, (4) preeclampsia without severe features, (5) gestational hypertension, or (6) no hypertensive diagnosis. Risks for 60-day readmission was determined based on hypertensive diagnosis at delivery. The following adverse outcomes during readmissions were analyzed: (1) stroke, (2) pulmonary edema and heart failure, (3) eclampsia, and (4) severe maternal morbidity (SMM). We fit multivariable log-linear regression models to assess the magnitude of association between hypertensive diagnoses at delivery and risks for readmission and associated complications with adjusted risk ratios (aRR) as measures of effect. RESULTS From 2010 to 2014, 15.7 million estimated delivery hospitalizations were included in the analysis. Overall risk for 60-day postpartum readmission was the highest among women with superimposed preeclampsia (6.6%), followed by preeclampsia with severe features (5.2%), chronic hypertension (4.0%), preeclampsia without severe features (3.9%), gestational hypertension (2.9%), and women without a hypertensive diagnosis (1.5%). In adjusted analyses for pulmonary edema and heart failure as the outcome, risks were the highest for preeclampsia with severe features (aRR = 7.82, 95% confidence interval [CI]: 6.03, 10.14), superimposed preeclampsia (aRR = 8.21, 95% CI: 5.79, 11.63), and preeclampsia without severe features (aRR = 8.87, 95% CI: 7.06, 11.15). In the adjusted model for stroke, risks were similarly highest for these three hypertensive diagnoses. Evaluating risks for SMM during postpartum readmission, chronic hypertension and superimposed preeclampsia were associated with the highest risks. CONCLUSION Chronic hypertension was associated with increased risk for a broad range of adverse postpartum outcomes. Risk estimates associated with chronic hypertension with and without superimposed preeclampsia were similar to preeclampsia with severe features for several outcomes. KEY POINTS · Chronic hypertension was associated with increased risk for a broad range of adverse outcomes.. · Close postpartum follow-up is required if hypertension is present at delivery.. · The majority of readmissions occurred within 10 days after delivery hospitalization discharge..
Collapse
Affiliation(s)
- Ukachi N Emeruwa
- Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Cynthia Gyamfi-Bannerman
- Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Timothy Wen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California
| | - Whitney Booker
- Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Jason D Wright
- Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Yongmei Huang
- Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Mary E D'Alton
- Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Alexander M Friedman
- Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
| |
Collapse
|
13
|
Amgai B, Patel N, Chakraborty S, Bandyopadhyay D, Hajra A, Koirala S, Ghosh RK, Aronow WS, Lavie CJ, Fonarow GC, Abbott JD, Kapadia S. 30-day readmission following urgent and elective transcatheter aortic valve replacement: A Nationwide Readmission Database analysis. Catheter Cardiovasc Interv 2021; 98:E1026-E1032. [PMID: 34410035 DOI: 10.1002/ccd.29918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/20/2021] [Accepted: 08/05/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is being increasingly used for decompensated severe symptomatic aortic stenosis. Data on urgent and elective TAVR readmission is scarce in the literature. Here, we have performed a retrospective cohort study with the Nationwide Readmission Database of 2016 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 TAVR. METHODS We used International Classification of Diseases, Tenth Revision codes (02R.F38H, 02R.F38Z, 02R.F48Z) for identification of all TAVR procedures done in 2016 in patients >18 years old. We found 8379 patients who underwent urgent TAVR and 32,006 patients who underwent elective TAVR in 2016. RESULT The mean age of patients undergoing urgent TAVR was 79 ± 9.97 years with 44.6% women. The mean age of patients undergoing elective TAVR was 80.7 ± 8.25 years with 46.2% women. We found the 30-day all-cause readmission rate of 15.5% and 9.5% in patients undergoing urgent and elective TAVR, 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 predominant cause of readmission and was similar in both groups (18.73 in urgent TAVR vs. 15.73 in elective TAVR, p = 0.12). CONCLUSION We found that the all-cause 30-day readmission rate was higher in patients who had undergone urgent TAVR. Further studies are needed to better understand this difference.
Collapse
Affiliation(s)
| | | | | | | | - Adrija Hajra
- Jacobi Medical Center/Albert Einstein College of Medicine, New York, New York, USA
| | - Soniya Koirala
- Institute of Medicine Tribhuvan University, Kathmandu, Nepal
| | - Raktim K Ghosh
- MedStar Heart and Vascular Institute, Union Memorial Hospital, Baltimore, Maryland, USA
| | - Wilbert S Aronow
- Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, California, USA
| | | | - Samir Kapadia
- Cleveland Clinic, Heart and Vascular Institute, Cleveland, Ohio, USA
| |
Collapse
|
14
|
Wen T, Fein AW, Wright JD, Mack WJ, Attenello FJ, D'Alton ME, Friedman AM. Postpartum Psychiatric Admissions in the United States. Am J Perinatol 2021; 38:115-121. [PMID: 31412407 DOI: 10.1055/s-0039-1694759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study aimed to assess risk for postpartum psychiatric admissions in the United States. STUDY DESIGN This study used the 2010 to 2014 Nationwide Readmissions Database to identify psychiatric admissions during the first 60 days after delivery hospitalization. Timing of admission after delivery discharge was determined. We fit multivariable log-linear regression models to assess the impact of psychiatric comorbidity on admission risk, adjusting for patient, obstetrical, and hospital factors. RESULTS Of 15.7 million deliveries from 2010 to 2014, 11,497 women (0.07%) were readmitted for a primary psychiatric diagnosis within 60 days postpartum. Psychiatric admissions occurred relatively consistently across 10-day periods after delivery hospitalization discharge. Psychiatric diagnoses were present among 5% of women at delivery but 40% of women who were readmitted postpartum for a psychiatric indication. In the adjusted model, women with psychiatric diagnoses at delivery hospitalization were 9.7 times more likely to be readmitted compared with those without psychiatric comorbidity. Women at highest risk for psychiatric admission were those with Medicare and Medicaid, in lower income quartiles, and of younger age. CONCLUSION While a large proportion of psychiatric admissions occurred among a relatively small proportion of at-risk women, admissions occurred over a broad temporal period relative to other indications for postpartum admission.
Collapse
Affiliation(s)
- Timothy Wen
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York
| | - Arielle W Fein
- Vagelos College of Physicians and Surgeons, Columbia University, New York
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York
| | - William J Mack
- Department of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Frank J Attenello
- Department of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York
| |
Collapse
|
15
|
Khoury H, Ragalie W, Sanaiha Y, Boutros H, Rudasill S, Shemin RJ, Benharash P. Readmission After Surgical Aortic Valve Replacement in the United States. Ann Thorac Surg 2020; 110:849-855. [DOI: 10.1016/j.athoracsur.2019.11.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 11/05/2019] [Accepted: 11/27/2019] [Indexed: 12/01/2022]
|
16
|
Dhoble A, Peerbhai S, Zhao Y, Vejpongsa P, Garcia‐Sayan E, Smalling RW, Estrera A, Nguyen TC. Rates, predictors, and outcomes of early readmissions after tricuspid valve surgery. J Card Surg 2020; 35:1848-1855. [DOI: 10.1111/jocs.14729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Abhijeet Dhoble
- Division of Cardiovascular Medicine University of Texas McGovern School of Medicine Houston Texas
- Memorial Herman Heart and Vascular Center Texas Medical Center Houston Texas
| | - Shareez Peerbhai
- Division of Cardiovascular Medicine University of Texas McGovern School of Medicine Houston Texas
- Memorial Herman Heart and Vascular Center Texas Medical Center Houston Texas
| | - Yelin Zhao
- Division of Cardiovascular Medicine University of Texas McGovern School of Medicine Houston Texas
| | - Pimprapa Vejpongsa
- Division of Cardiovascular Medicine University of Texas McGovern School of Medicine Houston Texas
- Memorial Herman Heart and Vascular Center Texas Medical Center Houston Texas
| | - Enrique Garcia‐Sayan
- Division of Cardiovascular Medicine University of Texas McGovern School of Medicine Houston Texas
- Memorial Herman Heart and Vascular Center Texas Medical Center Houston Texas
| | - Richard W. Smalling
- Division of Cardiovascular Medicine University of Texas McGovern School of Medicine Houston Texas
- Memorial Herman Heart and Vascular Center Texas Medical Center Houston Texas
| | - Anthony Estrera
- Division of Cardiovascular Medicine University of Texas McGovern School of Medicine Houston Texas
- Memorial Herman Heart and Vascular Center Texas Medical Center Houston Texas
| | - Tom C. Nguyen
- Division of Cardiovascular Medicine University of Texas McGovern School of Medicine Houston Texas
- Memorial Herman Heart and Vascular Center Texas Medical Center Houston Texas
| |
Collapse
|
17
|
Weiss MG, Møller JE, Dahl JS, Riber L, Sibilitz KL, Lykking EK, Borregaard B. Causes and characteristics associated with early and late readmission after open-heart valve surgery. J Card Surg 2020; 35:747-754. [PMID: 32048362 DOI: 10.1111/jocs.14460] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The objectives of the study were to describe the causes of readmission from discharge to 30 days and from day 31 to 180 after discharge and to investigate the characteristics associated with overall and cause-specific readmissions after open-heart valve surgery. METHODS A single-center, retrospective cohort of 980 patients undergoing open-heart valve surgery from 2013 to 2016. Time to the first readmission was analyzed using univariable and multivariable Cox proportional hazard models. Results are reported as hazard ratios (HR) with 95% confidence intervals (CI). RESULTS In total, 366 patients (37%) experienced unplanned cardiac readmission within 180 days after discharge. Within 30 days after discharge, the most frequent causes of readmission were pericardial/pleural effusions (n = 87), infections (n = 50), and atrial fibrillation/flutter (n = 45). Accordingly, infections (n = 32) were the most common cause from day 31 to 180. No powerful predictors of overall cardiac readmission were identified, but several characteristics were associated with cause-specific readmissions: age ≤65 years (HR: 1.85; CI: 1.18-2.88), male gender (HR: 1.85; CI: 1.11-3.09), high alcohol intake (HR: 1.99; CI: 1.22-3.24) and mitral valve procedures (HR: 1.86; CI: 1.11-3.10) were associated with readmissions due to effusions. Ischemic heart disease with a prior percutaneous coronary intervention (HR: 2.94; CI: 1.53-5.63), mitral valve procedures (HR: 2.10; CI: 1.23-3.59), and postoperative atrial fibrillation/flutter (HR: 1.71; CI: 1.03-2.85) were associated with atrial fibrillation/flutter readmissions. CONCLUSION Predicting overall readmissions after open-heart valve surgery is difficult as causes of readmissions vary and different causes are associated with different characteristics. Future studies should target reducing cause-specific readmissions.
Collapse
Affiliation(s)
- Marc G Weiss
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Jacob E Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Jordi S Dahl
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Lars Riber
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Kirstine L Sibilitz
- Department of Cardiology, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Emilie K Lykking
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
18
|
Impact of telephone follow-up and 24/7 hotline on 30-day readmission rates following aortic valve replacement -A randomized controlled trial. Int J Cardiol 2020; 300:66-72. [DOI: 10.1016/j.ijcard.2019.07.087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 07/11/2019] [Accepted: 07/29/2019] [Indexed: 12/16/2022]
|
19
|
Borregaard B, Møller JE, Dahl JS, Riber LPS, Berg SK, Ekholm O, Weiss MG, Lykking EK, Sibilitz KL, Sørensen J. Early follow-up after open heart valve surgery reduces healthcare costs: a propensity matched study. Open Heart 2019; 6:e001122. [PMID: 31798915 PMCID: PMC6861062 DOI: 10.1136/openhrt-2019-001122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/15/2019] [Accepted: 10/30/2019] [Indexed: 12/27/2022] Open
Abstract
Objectives The objective was to assess differences in healthcare costs within 180 days after discharge from open heart valve surgery in an intervention group receiving early, individualised and intensified follow-up compared with a historical control group. Methods A cost-minimisation analysis comparing costs from a consecutive prospective cohort compared with a propensity matched cohort. Costs related to the intervention, hospital (outpatient visits and readmissions) and general practitioners (all contacts) were included. Data were obtained from electronic patient records and registry data. A logistic propensity model was used to identify the historical control group. Main results are presented as mean differences and 95% CIs based on bootstrapping. Results After matching, the analysis included 300 patients from the intervention group and 580 controls. The mean intervention cost was €171 (SD 79) per patient. After 180 days, the mean healthcare costs were €1284 (SD 2567) for the intervention group and €2077 (SD 4773) for the controls. The cost of the intervention group was €793 (p<0.001) less per patient. The cost differences were explained mainly by fewer readmissions, fewer overall emergency visits and fewer contacts to the general practitioner during out-of-hours in the intervention group. Conclusions The intervention consisting of early, individualised and intensified follow-up after open heart valve surgery significantly reduced the healthcare costs within 180 days after discharge.
Collapse
Affiliation(s)
- Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense Universitetshospital, Odense, Denmark.,Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Open Patient Data Explorative Network, University of Southern Denmark, Odense, Denmark
| | - Jacob Eifer Møller
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense Universitetshospital, Odense, Denmark
| | - Jordi Sanchez Dahl
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense Universitetshospital, Odense, Denmark
| | - Lars Peter Schødt Riber
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Thoracic Surgery, Odense Universitetshospital, Odense, Denmark
| | - Selina Kikkenborg Berg
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicin, University of Copenhagen, Copenhagen, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Marc Gjern Weiss
- Department of Cardiothoracic and Vascular Surgery, Odense Universitetshospital, Odense, Denmark
| | - Emilie Karense Lykking
- Department of Cardiothoracic and Vascular Surgery, Odense Universitetshospital, Odense, Denmark
| | - Kirstine Lærum Sibilitz
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Jan Sørensen
- Healthcare Outcomes Research Centre (HORC), Royal College of Surgeons in Ireland Clinical Research Centre, Dublin, Ireland.,Centre for Health Economics Research (COHERE), National Institute of Public Health, University of Southern Denmark, Odense C, Denmark
| |
Collapse
|
20
|
Goldsweig A, Aronow HD. Identifying patients likely to be readmitted after transcatheter aortic valve replacement. Heart 2019; 106:256-260. [PMID: 31649048 DOI: 10.1136/heartjnl-2019-315381] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/06/2019] [Accepted: 10/08/2019] [Indexed: 11/03/2022] Open
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.
Collapse
Affiliation(s)
- Andrew Goldsweig
- Department of Cardiovascular Medicine, University of Nebraska Medical Center College of Medicine, Omaha, Nebraska, USA
| | - Herbert David Aronow
- Department of Cardiovascular Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA.,Cardiovascular Institute, Lifespan Health System, Providence, Rhode Island, USA
| |
Collapse
|
21
|
Bianco V, Kilic A, Gleason TG, Lee JS, Schindler J, Aranda-Michel E, Wang Y, Navid F, Kliner D, Cavalcante JL, Mulukutla SR, Sultan I. Long-term Hospital Readmissions After Surgical Vs Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2019; 108:1146-1152. [DOI: 10.1016/j.athoracsur.2019.03.077] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 03/17/2019] [Accepted: 03/25/2019] [Indexed: 01/01/2023]
|
22
|
Kwok CS, Balacumaraswami L, Mamas MA. Should we implement interventions to reduce readmissions in open heart valve surgery? Int J Cardiol 2019; 289:50-51. [PMID: 31056412 DOI: 10.1016/j.ijcard.2019.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 04/05/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Chun Shing Kwok
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK; Royal Stoke University Hospital, Stoke-on-Trent, UK.
| | | | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK; Royal Stoke University Hospital, Stoke-on-Trent, UK
| |
Collapse
|
23
|
Wen T, Batista N, Wright JD, D’Alton ME, Attenello FJ, Mack WJ, Friedman AM. Postpartum readmissions among women with opioid use disorder. Am J Obstet Gynecol MFM 2019; 1:89-98. [DOI: 10.1016/j.ajogmf.2019.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/20/2019] [Accepted: 02/26/2019] [Indexed: 10/27/2022]
|
24
|
Koeckert MS, Grossi EA, Vining PF, Abdallah R, Williams MR, Kalkut G, Loulmet DF, Zias EA, Querijero M, Galloway AC. Ninety-Day Readmissions of Bundled Valve Patients: Implications for Healthcare Policy. Semin Thorac Cardiovasc Surg 2019; 31:32-37. [DOI: 10.1053/j.semtcvs.2018.07.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/24/2018] [Indexed: 11/11/2022]
|
25
|
Wen T, Wright JD, Goffman D, D'Alton ME, Mack WJ, Attenello FJ, Friedman AM. Postpartum venous thromboembolism readmissions in the United States. Am J Obstet Gynecol 2018; 219:401.e1-401.e14. [PMID: 30017675 DOI: 10.1016/j.ajog.2018.07.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 06/26/2018] [Accepted: 07/02/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND There are limited data on when postpartum readmissions for thromboembolism occur after delivery hospitalizations on a population basis in the United States. OBJECTIVE We sought to characterize risk factors for and timing of postpartum venous thromboembolism readmission after delivery hospitalization discharge. STUDY DESIGN The Healthcare Cost and Utilization Project Nationwide Readmissions Database for calendar years 2013 and 2014 was used to perform a retrospective cohort study evaluating risk for readmission for venous thromboembolism within 60 days of discharge from a delivery hospitalization. Risks for deep vein thrombosis and pulmonary embolism were individually assessed. Obstetric, medical, demographic, and hospital factors associated with postpartum readmission for venous thromboembolism were analyzed. Risk was characterized as odds ratios with 95% confidence intervals. Both unadjusted and adjusted analyses were performed. Adjusted analyses included relevant obstetric, medical, demographic, and hospital factors within logistic regression models. RESULTS From Jan. 1 through Oct. 31 in 2013 and 2014, 6,269,641 delivery hospitalizations were included in the analysis. In all, 2975 cases of readmission for any venous thromboembolism were identified (4.7 per 10,000 delivery hospitalizations) including 1170 cases of deep vein thrombosis and 1805 cases of pulmonary embolism. In all, 69.6% of readmissions for any venous thromboembolism occurred within the first 20 days of discharge vs 22.3% and 8.0% at 21-40 and 41-60 days after discharge. Median times to readmission were 12.7, 14.0, and 11.7 days for venous thromboembolism, deep vein thrombosis, and pulmonary embolism, respectively. Women readmitted for any venous thromboembolism were more likely to have a history of venous thromboembolism (4.2% vs 0.3%, P < .01), to have had a cesarean delivery (54.4% vs 32.4%, P < .01), to have a thrombophilia (1.8% vs 0.4%, P < .01), to have had a longer delivery hospitalization of >3 days for vaginal delivery and >4 days for cesarean (18.0% vs 6.6%, P < .01), to have been diagnosed with gestational hypertension or preeclampsia (19.7% vs 8.2%, P < .01), and to have had postpartum hemorrhage with transfusion (2.6% vs 0.5%, P < .01). These factors retained significance in adjusted models. History of venous thromboembolism and hemorrhage with transfusion were associated with the largest odds of readmission (odds ratio, 9.5; 95% confidence interval, 6.6-13.6, and odds ratio, 3.6; 95% confidence interval, 2.4-5.5, respectively). Other factors associated with increased odds included thrombophilia (odds ratio, 2.0; 95% confidence interval, 1.2-3.5), cesarean delivery (odds ratio, 2.0; 95% confidence interval, 1.8-2.3), longer delivery hospitalization (odds ratio, 1.8; 95% confidence interval, 1.5-2.2), and preeclampsia or gestational hypertension (odds ratio, 2.0; 95% confidence interval, 1.6-2.4). CONCLUSION While the majority of events occurred within 20 days of discharge, risk factors other than thrombophilia and prior venous thromboembolism were generally associated with modestly increased odds of events, and only a small proportion of readmissions occurred among women with thrombophilia and prior events. Our data demonstrate both the challenging nature and urgent need for further research to determine which clinical practices and interventions may reduce risk for venous thromboembolism readmissions on a population basis.
Collapse
Affiliation(s)
- Timothy Wen
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Jason D Wright
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Dena Goffman
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - William J Mack
- Department of Neurological Surgery, Keck School of Medicine, Los Angeles, CA
| | - Frank J Attenello
- Department of Neurological Surgery, Keck School of Medicine, Los Angeles, CA
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY.
| |
Collapse
|
26
|
Danielsen SO, Moons P, Sandven I, Leegaard M, Solheim S, Tønnessen T, Lie I. Thirty-day readmissions in surgical and transcatheter aortic valve replacement: A systematic review and meta-analysis. Int J Cardiol 2018; 268:85-91. [DOI: 10.1016/j.ijcard.2018.05.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/09/2018] [Indexed: 11/24/2022]
|
27
|
Incidence, Prognostic Impact, and Predictive Factors of Readmission for Heart Failure After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2017; 10:2426-2436. [DOI: 10.1016/j.jcin.2017.09.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/05/2017] [Accepted: 09/13/2017] [Indexed: 11/18/2022]
|
28
|
Dhoble A, Bhise V, Nevah MI, Balan P, Nguyen TC, Estrera AL, Smalling RW. Outcomes and readmissions after transcatheter and surgical aortic valve replacement in patients with cirrhosis: A propensity matched analysis. Catheter Cardiovasc Interv 2017; 91:90-96. [DOI: 10.1002/ccd.27232] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 07/16/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Abhijeet Dhoble
- Division of Cardiology; University of Texas McGovern Medical School; Houston Texas
- Memorial Herman Heart and Vascular Center, Texas Medical Center; Houston Texas
| | - Viraj Bhise
- Division of Cardiology; University of Texas McGovern Medical School; Houston Texas
- School of Public Health; University of Texas; Houston Texas
| | - Moises I. Nevah
- Memorial Herman Heart and Vascular Center, Texas Medical Center; Houston Texas
- Division of Gastroenterology, Hepatology and Nutrition; University of Texas McGovern School of Medicine; Houston Texas
| | - Prakash Balan
- Division of Cardiology; University of Texas McGovern Medical School; Houston Texas
- Memorial Herman Heart and Vascular Center, Texas Medical Center; Houston Texas
| | - Tom C. Nguyen
- Memorial Herman Heart and Vascular Center, Texas Medical Center; Houston Texas
- Department of Cardiothoracic and Vascular Surgery; University of Texas McGovern School of Medicine; Houston Texas
| | - Anthony L. Estrera
- Memorial Herman Heart and Vascular Center, Texas Medical Center; Houston Texas
- Department of Cardiothoracic and Vascular Surgery; University of Texas McGovern School of Medicine; Houston Texas
| | - Richard W. Smalling
- Division of Cardiology; University of Texas McGovern Medical School; Houston Texas
- Memorial Herman Heart and Vascular Center, Texas Medical Center; Houston Texas
| |
Collapse
|