Key result
Non-home discharge occurred in 7.4% of TAVI patients and showed worse unadjusted survival (log-rank P=0.001), but was not independently associated with all-cause mortality (adjusted HR 1.54, P=0.18).
Why the study?
While discharge disposition has been widely investigated in cardiovascular surgeries, this study sought to examine the prevalence, predictors, and prognosis of non-home discharge specifically after TAVI.
Cohort (n=732)
No
Answers are grounded in this paper and cite their sources.
Non-home discharge after TAVI should not yet guide mortality risk stratification; leaves open whether it marks frailty or complications in larger cohorts.
Background: Transcatheter aortic valve implantation (TAVI) has been widely used as a valued alternative to surgical aortic valve replacement. In cardiovascular surgeries, discharge disposition has been widely investigated. We examined the prevalence and predictors of non-home discharge after TAVI, and the prognosis based on discharge destination. Methods and Results: We retrospectively analyzed 732 consecutive patients undergoing TAVI, and divided them into 2 groups: the home group (discharged directly home; n=678 [92.6%]) and the non-home group (n=54 [7.4%]). From baseline and procedural characteristics, peripheral artery disease (PAD; odds ratio [OR] 2.73; 95% confidence interval [CI] 1.25-5.97; P=0.012), previous stroke (OR 2.57; 95% CI 1.03-6.45; P=0.045), albumin level (OR 0.16 per 1-g/dL increase; 95% CI 0.07-0.39; P<0.001), and procedural stroke (OR 31.6; 95% CI 10.9-91.7; P<0.001) were independently associated with non-home discharge. In Kaplan-Meier analysis, the non-home group had worse survival than the home group (log-rank, P=0.001). In multivariate analysis, male sex, atrial fibrillation or atrial flutter, and low albumin concentrations were associated with all-cause mortality, but non-home discharge was not (P=0.18). Conclusions: Non-home discharge was recorded for 7.4% of patients undergoing TAVI, and was associated with PAD, nutritional status, and previous and procedural stroke. Non-home discharge reflects worse baseline characteristics, and may be a marker of mid-term outcome after TAVI.
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Muto et al. (2020) conducted a cohort in Symptomatic severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) (n=732). Non-home discharge after TAVI (to a rehabilitation facility, nursing home, or other acute hospital) vs. Direct home discharge after TAVI was evaluated on Post-discharge all-cause mortality after TAVI (HR 1.54, 95% CI 0.82-2.91, p=0.18). Non-home discharge occurred in 7.4% of TAVI patients and showed worse unadjusted survival (log-rank P=0.001), but was not independently associated with all-cause mortality (adjusted HR 1.54, P=0.18).
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