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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] [MESH Headings] [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.
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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
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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.
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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
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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.
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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
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Patel RV, Ravindran M, Manoragavan R, Sriharan A, Wijeysundera HC. Risk Factors for Hospital Readmission Post-Transcatheter Aortic Valve Implantation in the Contemporary Era: A Systematic Review. CJC Open 2022; 4:792-801. [PMID: 36148255 PMCID: PMC9486870 DOI: 10.1016/j.cjco.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 05/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Despite transcatheter aortic valve implantation (TAVI) becoming a widely accepted therapeutic option for the management of aortic stenosis, post-procedure readmission rates remain high. Rehospitalization is associated with negative patient outcomes, as well as increased healthcare costs, and has therefore been identified as an important target for quality improvement. Strategies to reduce the post-TAVI readmission rate are needed but require the identification of patients at high risk for rehospitalization. Our systematic review aims to identify predictors of post-procedure readmission in patients eligible for TAVI. Methods We conducted a comprehensive search of the MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases for the time period from 2015 to the present for articles evaluating risk factors for rehospitalization post-TAVI with a follow-up period of at least 30 days in adults age ≥ 70 years with aortic stenosis. The quality of included studies was evaluated using the Newcastle-Ottawa Scale. We present the results as a qualitative narrative review. Results We identified 49 studies involving 828,528 patients. Post-TAVI readmission is frequent, and rates vary (14.9% to 54.3% at 1 year). The most-frequent predictors identified for both 30-day and 1-year post-TAVI readmission are atrial fibrillation, lung disease, renal disease, diabetes mellitus, in-hospital life-threatening bleeding, and non-femoral access. Conclusions This systematic review identifies the most-common predictors for 30-day and 1-year readmission post-TAVI, including comorbidities and potentially modifiable procedural approaches and complications. These predictors can be used to identify patients at high-risk for readmission who are most likely to benefit from increased support and follow-up post-TAVI.
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Fischer-Rasokat U, Renker M, Liebetrau C, Weferling M, Rieth A, Rolf A, Choi YH, Hamm CW, Kim WK. Predictive value of overt and non-overt volume overload in patients with high- or low-gradient aortic stenosis undergoing transcatheter aortic valve implantation. Cardiovasc Diagn Ther 2021; 11:1080-1092. [PMID: 34815958 DOI: 10.21037/cdt-21-286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/08/2021] [Indexed: 11/06/2022]
Abstract
Background The plasma volume status (PVS) is considered a marker of non-overt cardiac congestion and is of prognostic value. Patients with low-flow, low-gradient (LFLG) aortic stenosis (AS) suffer from impaired left ventricular function and show signs of heart failure (HF). We hypothesized that PVS might predict post-interventional rehospitalization and cardiovascular mortality in high-risk patients undergoing transcatheter aortic valve implantation (TAVI). Methods In this retrospective, observational analysis, PVS before transfemoral TAVI was calculated by a formula taking into account hematocrit and weight. The predictive performance of PVS was compared with that of prior cardiac decompensation (PCD). Results In the entire cohort of n=2,458 patients, PVS >-4% (high plasma volume) identified patients (n=1,013) with a higher post-interventional 1-year mortality rate than patients (n=1,445) with a PVS ≤-4% (low plasma volume). However, PVS lost prognostic independence when adjusted for anemia, whereas PCD did not. A high PVS and PCD were not correlated, and both parameters similarly revealed a low sensitivity and specificity but a high negative predictive value (NPV) for future HF events. PVS was not different between control patients (n=1,512) and those with intermediate (paradoxical LFLG-AS, n=327) or high risk scores (LFLG-AS, n=239). The accuracy of high PVS in predicting adverse events in these subpopulations was the same as in the study population overall. Kaplan-Maier analyses demonstrated similar prognostic impacts for PVS and PCD. Conclusions PVS and PCD represent two independent parameters of volume overload with unfavorable prognostic significance. Pre-interventional PVS does not appear to be suitable for predicting clinical outcomes in high-risk patients undergoing TAVI.
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Affiliation(s)
| | - Matthias Renker
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.,Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim, Germany
| | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim, Germany.,Cardioangiological Center Bethanien (CCB), Frankfurt, Germany
| | - Maren Weferling
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim, Germany
| | - Andreas Rieth
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim, Germany
| | - Andreas Rolf
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim, Germany.,Medical Clinic I (Cardiology and Angiology), University Hospital of Giessen, Giessen, Germany
| | - Yeong-Hoon Choi
- Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim, Germany.,Medical Clinic I (Cardiology and Angiology), University Hospital of Giessen, Giessen, Germany
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.,Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim, Germany.,Medical Clinic I (Cardiology and Angiology), University Hospital of Giessen, Giessen, Germany
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Brouessard C, Bobet AS, Mathieu M, Manigold T, Arrigoni PP, Le Tourneau T, De Decker L, Boureau AS. Impact of Severe Sarcopenia on Rehospitalization and Survival One Year After a TAVR Procedure in Patients Aged 75 and Older. Clin Interv Aging 2021; 16:1285-1292. [PMID: 34262268 PMCID: PMC8274520 DOI: 10.2147/cia.s305635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/04/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Transcatheter aortic-valve replacement (TAVR) reduces mortality and improves quality of life in patients with severe aortic valve stenosis. One third of patients have no benefit one year after TAVR. Sarcopenia, an age-related loss of skeletal muscle mass, is associated with increased physical disability and mortality. The main purpose was to evaluate the impact of severe sarcopenia on rehospitalization one year after TAVR in older patients. METHODS All patients aged ≥75 referred for a TAVR in 2018 were included. Severe sarcopenia was defined by a loss of skeletal muscle mass defined on CT-scan measurement associated with a gait speed ≤0.8m/s. The main outcome was rehospitalization one year after TAVR. RESULTS Median age of the 182 included patients was 84, and 35% had an unplanned hospitalization at one year. Severe sarcopenia was diagnosed in 9 patients (4.9%). Univariable analysis showed that gait speed was a factor associated with readmission [HR=0.32, 95% CI (0.10-0.97), p=0.04] but not severe sarcopenia. In multivariable analysis, only diabetes was significantly associated with rehospitalization [HR=2.06, 95% CI (1.11-3.84), p=0.02]. Prevalence of severe sarcopenia varied according to different thresholds of skeletal muscle mass on CT-scan. CONCLUSION Even though severe sarcopenia was not correlated with rehospitalization and mortality at one year after TAVR, our results emphasize the changes in the prevalence according to cutoff used. It highlights the need to define standardized methods and international threshold for sarcopenia diagnosis by CT-scan measurements, in general population and for patients with valvular heart disease.
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Affiliation(s)
| | | | - Marie Mathieu
- Department of Geriatrics, University Hospital, Nantes, France
| | - Thibaut Manigold
- Department of Cardiology, Institut du Thorax, University Hospital, Nantes, France
| | | | - Thierry Le Tourneau
- Université de Nantes, CHU Nantes, CNRS, INSERM, Institut du Thorax, Nantes, F-44000, France
| | - Laure De Decker
- Department of Geriatrics, University Hospital, Nantes, France
| | - Anne-Sophie Boureau
- Department of Geriatrics, University Hospital, Nantes, France
- Université de Nantes, CHU Nantes, CNRS, INSERM, Institut du Thorax, Nantes, F-44000, France
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