Direct-Home Discharge and Readmission 30 Days After TAVR

There is no significant association between the hospital practice of direct-home discharge post-transcatheter aortic valve replacement (TAVR) and 30-day readmission, according to a study published Aug. 21 in the Journal of the American Heart Association.

Using data from the STS/ACC TVT Registry, John A. Dodson, MD, MPH, FACC, et al., analyzed 18,568 TAVR patients between Nov. 9, 2011 and March 31, 2015. The 329 U.S. hospitals included in the study were divided into quartiles based on the percentage of patients discharged directly home. Overall, hospitals discharged 69 percent of patients home post-TAVR. Hospitals in the highest quartile typically had fewer female patients (44.6 percent vs. 51.8 percent, P<0.001) and more nonwhite patients (7 percent vs. 3.5 percent, P<0.001) compared with hospitals in the lowest quartile. Additionally, hospitals in the highest quartile were more likely to use femoral access (75.2 percent vs. 60 percent) and had fewer patients receiving a transfusion (26.4 percent vs. 40.9 percent).

The median 30-day readmission rate was 17.9 percent. Glomerular filtration rate, in-hospital stroke or transient ischemic attack, and nonfemoral access were the most strongly associated with readmission. However, even after multivariable adjustment, researchers did not find a significant difference in 30-day readmissions (P=0.14) or mortality within 30 days (P=0.39) among the hospital quartiles. "Based on this finding it appears that factors other than discharge disposition predominate in determining readmission risk," the study authors said.

Of all the results, the most surprising was the regional variation across the U.S. in skilled nursing facility (SNF) use. For example, the authors note that “hospitals in the highest quartile of direct home discharge were, on average, most likely to be in the Southern United States and least likely to be in the Northeast United States.” While patients in the northeast had the highest median STS predicted mortality score, patient differences between regions was not significant.

Local institutional practice may have a larger impact on SNF discharge, the study authors said. Further research is needed to understand the reasons for this regional variation and what proportion of readmissions could be prevented and how.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention

Keywords: Ischemic Attack, Transient, Skilled Nursing Facilities, Patient Readmission, Transcatheter Aortic Valve Replacement, American Heart Association, Research Personnel, Institutional Practice, Glomerular Filtration Rate, Patient Discharge, Stroke, Registries, Hospitals, New England

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