Patients undergoing TAVR who spend more than three days in the hospital have a higher risk of mortality at one year, compared with patients discharged less than 72 hours after the procedure, according to a study published March 4 in JACC: Cardiovascular Interventions.

In the first large-scale study looking at length of stay following transfemoral TAVR, Siddharth A. Wayangankar, MD, FACC, et al., used the STS/ACC TVT Registry to assess trends, predictors and outcomes in 24,285 patients who underwent TAVR between 2011 and 2015.

Results show that 44.9 percent of patients had a delayed discharge, and 55.1 percent were discharged within 72 hours. Patients with mitral valve procedures, home oxygen, heart failure, atrial fibrillation, dialysis and severe kidney disease were more likely to be discharged after 72 hours. In addition, patients who were older than 85, African-American or Hispanic were more likely to have a delayed discharge. Independent predictors of early discharge within 72 hours include presence of an ICD and prior CABG or MI, as well as being younger than 85, male or white. After adjusting for in-hospital complications, delayed discharge was associated with significantly higher one-year all-cause mortality (hazards ratio 1.45, 95 percent confidence interval, 1.30-1.60). During the study period, the rate of delayed discharge declined from 62 percent in 2011 to 34 percent in 2015.

According to the researchers, additional research is needed to determine whether predictors of delayed vs. early discharge could inform the development of risk-score models to improve patient selection and post-TAVR care for those at higher risk of delayed discharge. They also note that the significant decrease in post-TAVR length of stay is likely the result of nationwide efforts aimed at optimizing TAVR programs. They add that this trend is likely continue with "continued refinement and techniques and patient selection."

In an accompanying editorial comment, Marco Barbanti, MD, writes increased experience in management of post-TAVR patients and new training programs played a "predominant role" in decreased length of stay during the study period. He adds that the study demonstrates "important progress toward optimization of the post-procedure management and timely discharge" for TAVR patients.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure

Keywords: Atrial Fibrillation, Renal Dialysis, Transcatheter Aortic Valve Replacement, Mitral Valve, Length of Stay, Kidney, Kidney Diseases, Patient Discharge, Registries, Heart Failure, National Cardiovascular Data Registries, STS/ACC TVT Registry

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