Fragmented Care Following TAVR Linked to Poorer Outcomes

The treatment of a patient at a second hospital within 90 days following a transcatheter aortic valve replacement (TAVR) procedure was associated with an increase in one-year mortality and readmissions. This "fragmented" treatment at a second institution often occurs when a patient lives in a remote area and faces a long drive to a referral center for a TAVR evaluation and procedure, according to a study published in the American Journal of Cardiology.

Alice Wang, MD, MHS, et al., examined data from 8,927 patients in 374 institutions who had a TAVR procedure between 2011 and 2015 and were enrolled in the STS/ACC TVT Registry, linked to Centers for Medicare and Medicaid Services' claims data. Among these patients, 27.4 percent were readmitted within 90 days of discharge and 57 percent of those readmitted received fragmented care. Fragmented care was defined as a patient being readmitted to a hospital other than the site of the TAVR procedure within 90 days after discharge.

When compared with patients who were treated at the same hospital where their TAVR procedure was performed, patients receiving fragmented care were more likely to have moderate to severe chronic lung disease, cerebrovascular disease and heart failure within two weeks, according to researchers.

Patients living more than 30 minutes from the site of their TAVR procedure had an increased risk of fragmented care. Researchers also found an unequal distribution of TAVR volume relative to Medicare patients at the state level. Assuming a relatively homogenous distribution of patients over age 65 with severe aortic stenosis, this may represent unequal geographic access to TAVR centers.

"Fragmented readmission following TAVR is common and is associated with increased one-year mortality and readmission," the researchers concluded. "Efforts to improve coordination of care may improve these outcomes and optimize long-term benefits yielded from TAVR.

Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Structural Heart Disease, Interventions and Vascular Medicine

Keywords: National Cardiovascular Data Registries, STS/ACC TVT Registry, Humans, United States, Transcatheter Aortic Valve Replacement, Patient Readmission, Centers for Medicare and Medicaid Services (U.S.), Aortic Valve Stenosis, Aortic Valve, Medicare, Medicaid, Registries, Heart Failure, Cerebrovascular Disorders, Referral and Consultation, Lung Diseases


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