Hospital readmission following transcatheter aortic valve implantation in the real world. (15th October 2018)

• Record Type: Journal Article
• Authors: Arai, Takahide; Yashima, Fumiaki; Yanagisawa, Ryo; Tanaka, Makoto; Shimizu, Hideyuki; Fukuda, Keiichi; Watanabe, Yusuke; Naganuma, Toru; Araki, Motoharu; Tada, Norio; Yamanaka, Futoshi; Shirai, Shinichi; Yamamoto, Masanori; Hayashida, Kentaro
• Is Part Of: International journal of cardiology. Volume 269(2018)
• Page Start: 56
• Page End: 60
• Publication Date: 2018-10-15
• Subjects: Severe symptomatic aortic stenosis -- Transcatheter aortic valve implantation -- Readmission; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2018.07.073
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: There is limited data on hospital readmissions following transcatheter aortic valve implantation (TAVI). The aim of this study was to investigate hospital readmissions post-TAVI. Methods: Data from the Optimized transCathEter vAlvular iNtervention (OCEAN-TAVI) multicenter registry (registration no. UMIN000020423) were collected from 1215 patients who underwent TAVI. Incidence, timing, causes, and predictors of readmission in addition to the impact on patient outcomes were analyzed. Results: Of 1215 patients, 223 (18.4%) were readmitted within 1 year post-TAVI. Early readmission (≤30 days) occurred in 42 patients, while late readmission (>30 days) occurred in 181 patients. Readmissions were due to cardiac disorders, such as heart failure and arrhythmia, in 77 patients and non-cardiac disorders, such as respiratory disorders, infections, and cerebrovascular events, in 146 patients. Kaplan-Meier analysis revealed that early readmission was associated with a lower 1-year survival compared to non-early readmission (72.4% vs. 89.0%, p < 0.05). Multivariate Cox regression analysis showed that acute kidney injury (hazard ratio [HR], 2.27; p = 0.03) was an independent predictor of early readmission, while anemia (HR, 2.21; p < 0.01), hypoalbuminemia (HR, 1.37; p = 0.04), atrial fibrillation (HR, 1.70; p < 0.01), and more than mild postprocedural aortic regurgitation (HR, 1.62; p < 0.01) were independent predictors of late readmission. Conclusion: Readmission occurred in approximately one-fifth of patients post-TAVI and was associated with poor patient outcomes. Early readmission was mainly due to procedural complications, while late readmission was mainly determined by baseline comorbidities including a frailty criterion. Measures should be taken to reduce hospital readmissions and improve patient outcomes post-TAVI. Highlights: Readmission occurred in approximately one-fifth of patients post-TAVI. Readmission was associated with poor patient outcomes. Early readmission was mainly due to procedural complications. Late readmission was mainly determined by baseline comorbidities including a frailty criterion.