Discharge Location and Outcomes After Transcatheter Aortic Valve Implantation
The relation between discharge location and outcomes after transcatheter aortic valve implantation (TAVI) is largely unknown. Thus, the objective of this study was to investigate the impact of discharge location on clinical outcomes after TAVI. Between August 2007 and December 2018, consecutive pati...
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| Veröffentlicht in: | The American journal of cardiology 2021-02, Vol.140, p.95-102 |
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| creator | Sweda, Romy Dobner, Stephan Heg, Dik Lanz, Jonas Malebranche, Daniel Langhammer, Bettina Okuno, Taishi Praz, Fabien Räber, Lorenz Valgimigli, Marco Reineke, David Pilgrim, Thomas Windecker, Stephan Stortecky, Stefan |
| description | The relation between discharge location and outcomes after transcatheter aortic valve implantation (TAVI) is largely unknown. Thus, the objective of this study was to investigate the impact of discharge location on clinical outcomes after TAVI. Between August 2007 and December 2018, consecutive patients who underwent transfemoral TAVI at Bern University Hospital were grouped according to discharge location. Clinical adverse events were adjudicated according to VARC-2 end point definitions. Of 1,902 eligible patients, 520 (27.3%) were discharged home, 945 (49.7%) were discharged to a rehabilitation clinic and 437 (23.0%) were transferred to another institution. Compared with patients discharged to a rehabilitation facility or another institution, patients discharged home were younger (80.8 ± 6.5 vs 82.9 ± 5.4 and 82.8 ± 6.4 years), less likely female (37.3% vs 59.7% and 54.2%), and at lower risk according to STS-PROM (4.5 ± 3.0% vs 5.5 ± 3.8% and 6.6 ± 4.4%). At 1 year follow-up, patients discharged home had similar rates of all-cause mortality (HRadj 0.82; 95% CI 0.54 to 1.24), cerebrovascular events (HRadj 1.04; 95% CI 0.52 to 2.08) and bleeding complications (HRadj 0.93; 95% CI 0.61 to 1.41) compared with patients discharged to a rehabilitation facility. Patients discharged home or to rehabilitation were at lower risk for death (HRadj 0.37; 95% CI 0.24 to 0.56 and HRadj 0.44; 95% CI 0.32 to 0.60) and bleeding (HRadj 0.48; 95% CI 0.30 to 0.76 and HRadj 0.66; 95% CI 0.45 to 0.96) during the first year after hospital discharge compared with patients transferred to another institution. In conclusion, discharge location is associated with outcomes after TAVI with patients discharged home or to a rehabilitation facility having better clinical outcomes than patients transferred to another institution.
Clinical Trial Registration: https://www.clinicaltrials.gov. NCT01368250. |
| doi_str_mv | 10.1016/j.amjcard.2020.10.058 |
| format | Article |
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Clinical Trial Registration: https://www.clinicaltrials.gov. NCT01368250.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2020.10.058</identifier><identifier>PMID: 33144166</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adverse events ; Aged, 80 and over ; Aorta ; Aortic valve ; Aortic Valve - surgery ; Aortic Valve Stenosis - surgery ; Bleeding ; Cardiac arrhythmia ; Clinical outcomes ; Complications ; Ejection fraction ; Female ; Follow-Up Studies ; General anesthesia ; Heart surgery ; Heart valves ; Hospitals ; Humans ; Implantation ; Incidence ; Kidneys ; Male ; Mortality ; Patient Discharge - statistics & numerical data ; Patients ; Postoperative Complications - epidemiology ; Registries ; Rehabilitation ; Retrospective Studies ; Risk Assessment - methods ; Risk Factors ; Switzerland - epidemiology ; Time Factors ; Transcatheter Aortic Valve Replacement - methods ; Transplants & implants ; Treatment Outcome</subject><ispartof>The American journal of cardiology, 2021-02, Vol.140, p.95-102</ispartof><rights>2020 Elsevier Inc.</rights><rights>Copyright © 2020 Elsevier Inc. All rights reserved.</rights><rights>2020. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c440t-b65eb43ed9eda550df5ff1cd486637774581545a503d08aba3bae2d99563d5743</citedby><cites>FETCH-LOGICAL-c440t-b65eb43ed9eda550df5ff1cd486637774581545a503d08aba3bae2d99563d5743</cites><orcidid>0000-0002-5076-0177 ; 0000-0003-2220-9799 ; 0000-0001-7831-2934 ; 0000-0002-5035-6625 ; 0000-0001-8721-4068</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002914920311917$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33144166$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sweda, Romy</creatorcontrib><creatorcontrib>Dobner, Stephan</creatorcontrib><creatorcontrib>Heg, Dik</creatorcontrib><creatorcontrib>Lanz, Jonas</creatorcontrib><creatorcontrib>Malebranche, Daniel</creatorcontrib><creatorcontrib>Langhammer, Bettina</creatorcontrib><creatorcontrib>Okuno, Taishi</creatorcontrib><creatorcontrib>Praz, Fabien</creatorcontrib><creatorcontrib>Räber, Lorenz</creatorcontrib><creatorcontrib>Valgimigli, Marco</creatorcontrib><creatorcontrib>Reineke, David</creatorcontrib><creatorcontrib>Pilgrim, Thomas</creatorcontrib><creatorcontrib>Windecker, Stephan</creatorcontrib><creatorcontrib>Stortecky, Stefan</creatorcontrib><title>Discharge Location and Outcomes After Transcatheter Aortic Valve Implantation</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>The relation between discharge location and outcomes after transcatheter aortic valve implantation (TAVI) is largely unknown. Thus, the objective of this study was to investigate the impact of discharge location on clinical outcomes after TAVI. Between August 2007 and December 2018, consecutive patients who underwent transfemoral TAVI at Bern University Hospital were grouped according to discharge location. Clinical adverse events were adjudicated according to VARC-2 end point definitions. Of 1,902 eligible patients, 520 (27.3%) were discharged home, 945 (49.7%) were discharged to a rehabilitation clinic and 437 (23.0%) were transferred to another institution. Compared with patients discharged to a rehabilitation facility or another institution, patients discharged home were younger (80.8 ± 6.5 vs 82.9 ± 5.4 and 82.8 ± 6.4 years), less likely female (37.3% vs 59.7% and 54.2%), and at lower risk according to STS-PROM (4.5 ± 3.0% vs 5.5 ± 3.8% and 6.6 ± 4.4%). At 1 year follow-up, patients discharged home had similar rates of all-cause mortality (HRadj 0.82; 95% CI 0.54 to 1.24), cerebrovascular events (HRadj 1.04; 95% CI 0.52 to 2.08) and bleeding complications (HRadj 0.93; 95% CI 0.61 to 1.41) compared with patients discharged to a rehabilitation facility. Patients discharged home or to rehabilitation were at lower risk for death (HRadj 0.37; 95% CI 0.24 to 0.56 and HRadj 0.44; 95% CI 0.32 to 0.60) and bleeding (HRadj 0.48; 95% CI 0.30 to 0.76 and HRadj 0.66; 95% CI 0.45 to 0.96) during the first year after hospital discharge compared with patients transferred to another institution. In conclusion, discharge location is associated with outcomes after TAVI with patients discharged home or to a rehabilitation facility having better clinical outcomes than patients transferred to another institution.
Clinical Trial Registration: https://www.clinicaltrials.gov. NCT01368250.</description><subject>Adverse events</subject><subject>Aged, 80 and over</subject><subject>Aorta</subject><subject>Aortic valve</subject><subject>Aortic Valve - surgery</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Bleeding</subject><subject>Cardiac arrhythmia</subject><subject>Clinical outcomes</subject><subject>Complications</subject><subject>Ejection fraction</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>General anesthesia</subject><subject>Heart surgery</subject><subject>Heart valves</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Implantation</subject><subject>Incidence</subject><subject>Kidneys</subject><subject>Male</subject><subject>Mortality</subject><subject>Patient Discharge - statistics & numerical data</subject><subject>Patients</subject><subject>Postoperative Complications - epidemiology</subject><subject>Registries</subject><subject>Rehabilitation</subject><subject>Retrospective Studies</subject><subject>Risk Assessment - 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surgery</topic><topic>Aortic Valve Stenosis - surgery</topic><topic>Bleeding</topic><topic>Cardiac arrhythmia</topic><topic>Clinical outcomes</topic><topic>Complications</topic><topic>Ejection fraction</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>General anesthesia</topic><topic>Heart surgery</topic><topic>Heart valves</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Implantation</topic><topic>Incidence</topic><topic>Kidneys</topic><topic>Male</topic><topic>Mortality</topic><topic>Patient Discharge - statistics & numerical data</topic><topic>Patients</topic><topic>Postoperative Complications - epidemiology</topic><topic>Registries</topic><topic>Rehabilitation</topic><topic>Retrospective Studies</topic><topic>Risk Assessment - methods</topic><topic>Risk Factors</topic><topic>Switzerland - epidemiology</topic><topic>Time Factors</topic><topic>Transcatheter Aortic Valve Replacement - methods</topic><topic>Transplants & implants</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sweda, Romy</creatorcontrib><creatorcontrib>Dobner, Stephan</creatorcontrib><creatorcontrib>Heg, Dik</creatorcontrib><creatorcontrib>Lanz, Jonas</creatorcontrib><creatorcontrib>Malebranche, Daniel</creatorcontrib><creatorcontrib>Langhammer, Bettina</creatorcontrib><creatorcontrib>Okuno, Taishi</creatorcontrib><creatorcontrib>Praz, Fabien</creatorcontrib><creatorcontrib>Räber, Lorenz</creatorcontrib><creatorcontrib>Valgimigli, Marco</creatorcontrib><creatorcontrib>Reineke, David</creatorcontrib><creatorcontrib>Pilgrim, Thomas</creatorcontrib><creatorcontrib>Windecker, Stephan</creatorcontrib><creatorcontrib>Stortecky, Stefan</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Biochemistry Abstracts 1</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sweda, Romy</au><au>Dobner, Stephan</au><au>Heg, Dik</au><au>Lanz, Jonas</au><au>Malebranche, Daniel</au><au>Langhammer, Bettina</au><au>Okuno, Taishi</au><au>Praz, Fabien</au><au>Räber, Lorenz</au><au>Valgimigli, Marco</au><au>Reineke, David</au><au>Pilgrim, Thomas</au><au>Windecker, Stephan</au><au>Stortecky, Stefan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Discharge Location and Outcomes After Transcatheter Aortic Valve Implantation</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2021-02-01</date><risdate>2021</risdate><volume>140</volume><spage>95</spage><epage>102</epage><pages>95-102</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><abstract>The relation between discharge location and outcomes after transcatheter aortic valve implantation (TAVI) is largely unknown. Thus, the objective of this study was to investigate the impact of discharge location on clinical outcomes after TAVI. Between August 2007 and December 2018, consecutive patients who underwent transfemoral TAVI at Bern University Hospital were grouped according to discharge location. Clinical adverse events were adjudicated according to VARC-2 end point definitions. Of 1,902 eligible patients, 520 (27.3%) were discharged home, 945 (49.7%) were discharged to a rehabilitation clinic and 437 (23.0%) were transferred to another institution. Compared with patients discharged to a rehabilitation facility or another institution, patients discharged home were younger (80.8 ± 6.5 vs 82.9 ± 5.4 and 82.8 ± 6.4 years), less likely female (37.3% vs 59.7% and 54.2%), and at lower risk according to STS-PROM (4.5 ± 3.0% vs 5.5 ± 3.8% and 6.6 ± 4.4%). At 1 year follow-up, patients discharged home had similar rates of all-cause mortality (HRadj 0.82; 95% CI 0.54 to 1.24), cerebrovascular events (HRadj 1.04; 95% CI 0.52 to 2.08) and bleeding complications (HRadj 0.93; 95% CI 0.61 to 1.41) compared with patients discharged to a rehabilitation facility. Patients discharged home or to rehabilitation were at lower risk for death (HRadj 0.37; 95% CI 0.24 to 0.56 and HRadj 0.44; 95% CI 0.32 to 0.60) and bleeding (HRadj 0.48; 95% CI 0.30 to 0.76 and HRadj 0.66; 95% CI 0.45 to 0.96) during the first year after hospital discharge compared with patients transferred to another institution. In conclusion, discharge location is associated with outcomes after TAVI with patients discharged home or to a rehabilitation facility having better clinical outcomes than patients transferred to another institution.
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| subjects | Adverse events Aged, 80 and over Aorta Aortic valve Aortic Valve - surgery Aortic Valve Stenosis - surgery Bleeding Cardiac arrhythmia Clinical outcomes Complications Ejection fraction Female Follow-Up Studies General anesthesia Heart surgery Heart valves Hospitals Humans Implantation Incidence Kidneys Male Mortality Patient Discharge - statistics & numerical data Patients Postoperative Complications - epidemiology Registries Rehabilitation Retrospective Studies Risk Assessment - methods Risk Factors Switzerland - epidemiology Time Factors Transcatheter Aortic Valve Replacement - methods Transplants & implants Treatment Outcome |
| title | Discharge Location and Outcomes After Transcatheter Aortic Valve Implantation |
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