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Discharge disposition of older patients undergoing trans‐catheter aortic valve replacement and its impact on survival
Author(s) -
Okoh Alexis K.,
Haik Nicky,
Singh Swaiman,
Kaur Komalpreet,
Fugar Setri,
Cohen Marc,
Haik Bruce,
Chen Chunguang,
Russo Mark J.
Publication year - 2019
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28069
Subject(s) - medicine , propensity score matching , valve replacement , odds ratio , logistic regression , incidence (geometry) , diabetes mellitus , log rank test , confidence interval , survival analysis , surgery , cardiology , stenosis , physics , optics , endocrinology
Background Patients undergoing transcatheter aortic valve replacement (TAVR) are likely to be discharged to a location other than home. We aimed to assess the association between discharge disposition after TAVR and patient survival at 1 year. Methods Patients admitted from home and survived till discharge after TAVR were divided into two groups based on discharge disposition (home discharge vs. non‐home discharge). Pre‐operative factors predicting the odds of not being discharged home were identified by using multivariable logistic regression analysis. Study patients were matched one‐to‐one via a propensity scoring method. Differences in procedural outcomes were compared. Survival of both unmatched and matched pairs was evaluated by using the Kaplan‐Meier method with the Kleine‐Moesch‐Berger stratified log‐rank test. Results Out of 1,160 TAVR patients, 851 were admitted from home and survived till discharge. The incidence non‐home discharge was 19% (n = 159). Factors that were significantly associated with non‐home discharge were older age, non‐transfemoral approach, female sex, frailty status, history of chronic lung disease, pacemaker placement and insulin‐dependent diabetes mellitus. One‐to‐one propensity score matching resulted in 141 patient pairs with similar age, operative risk, frailty and functional status. At 1‐year follow‐up, all‐cause mortality rates were significantly higher in the non‐home group than their home counterparts (18% vs. 3%, P = 0.006; stratified log rank test: P = 0.006). Conclusions A considerable number of TAVR patients are discharged to a location other than home after the procedure. Not being discharged home after TAVR is associated with a high mortality risk at 1 year.