Delayed discharge after TAVR linked to higher mortality

A late-breaking study presented at SCAI 2018 demonstrated that patients who stay in the hospital for more than 72 hours after transcatheter aortic valve replacement (TAVR) are more likely to die in the following year than those with earlier discharges.

Researchers analyzed registry data for 32,847 individuals undergoing transfemoral TAVR from 2011 to 2015. They used a 72-hour cutoff to define each patient as early discharge or late discharge.

Shorter hospital stays were significantly associated with lower one-year mortality (11 percent versus 15.6 percent) and a lower likelihood of bleeding requiring hospitalization (13.9 percent versus 18.4 percent). In addition, study coauthor Siddharth Wayangankar, MD, and colleagues identified several predictors of delayed discharge including poor kidney function, prior mitral valve procedures, use of home oxygen, African-American race and TAVR with self-expanding valves.

“The predictors from our study could have a huge impact on future clinical care of TAVR patients,” Wayangankar, an assistant professor of medicine at the University of Florida, said in a press release. “Pre-TAVR, these predictors could be used to develop bedside risk scores for LOS (length of stay). These could help physicians in patient selection, procedural and post-procedural planning based on patient-specific variables. On a much bigger front, these risk scores could be used by administrators, third-party payers and policy makers for formulating coverage for TAVR procedures and evaluating bundle payments.”

The authors also noted a decline in the rates of delayed discharge throughout the study period, dropping from 62.2 percent in the first quarter of 2012 to 34.4 percent in the third quarter of 2015.

Wayangankar said their study could also signal clinicians to be more rigorous in their follow up of patients who required long hospital stays for TAVR. Paying special attention to these patients could limit the excess mortality and rehospitalization risk observed in this study, he noted.