E-9 | The Home Field Advantage: The Relationship Between Discharge Disposition and TAVR Outcomes

Transcatheter aortic valve replacement (TAVR) is a less invasive treatment option for aortic stenosis compared to open-heart surgery. Studies have shown that discharge disposition to home can be associated with better outcomes for TAVR patients. Our study aims to investigate the relationship between discharge disposition and outcomes of patients undergoing TAVR at 6 and 12 months. We conducted a retrospective analysis of patients undergoing TAVR from 2018-2022 at a major academic medical center in Chicago. Patients were categorized as discharged home (DH) or discharged elsewhere (DO), in which the patients were discharged to a skilled nursing facility, acute care hospital, or other location. Exclusion criteria consisted of death prior to discharge or no documentation of discharge location. Primary outcomes included composite MACE (all-cause mortality, myocardial infarction [MI], and/or cerebrovascular accident [CVA]) at 6 and 12 months. T and Chi square tests were conducted for continuous and categorical variables respectively. A total of 221 patients were included in the analysis. 74% were male, 40% were white, and the mean age was 76 ± 10 years. There were 18 (8.1%) patients in the DO group. There was no difference in age, gender, comorbidities, and medications (cardiac and antithrombotic) at baseline between the two groups. The DO group had a longer length of stay compared to DH patients (8.7 vs. 2.2 days, p<0.001). At 6 months, DO patients experienced greater instances of composite MACE (33.3% vs. 5.4%, p<0.001) and death (27.8% vs. 3.5%, p<0.001) than DH patients. At 12 months, the DO group was also more likely to experience composite MACE (38.9% vs. 12.8%, p=0.003) and death (33.3% vs. 7.9%, p=0.001) than DH patients. DO patients also had more conduction abnormalities at 6 months (p=0.023). No significant differences were found in death at 30 days, CVA, MI, congestive heart failure exacerbation, and bleed events. Our study suggests that patients discharged at home experience fewer instances of MACE, death, and conduction abnormalities than patients discharged elsewhere. Discharge disposition may serve as a marker for patients that need earlier follow up and more resources after TAVR.