Study Evaluates Clinical Impact of Length of Hospital Stay After TAVR
May 4, 2018—The Society for Cardiovascular Angiography and Interventions (SCAI) announced that findings from a new, first-of-its-kind study presented at the 2018 SCAI scientific sessions demonstrated that patients who stay in the hospital for more than 72 hours when undergoing a transfemoral transcatheter aortic valve replacement (TF-TAVR) procedure may be associated with negative short-term and long-term outcomes.
The study's investigators also reported a significant decline in the rates of delayed discharge and identified independent predictors of both delayed and early discharge post-TAVR. The 2018 SCAI scientific sessions were held April 25–28 in San Diego, California.
According to SCAI, the aim of this study was to investigate the trends, predictors, and outcomes associated with length of stay (LOS) after TF-TAVR. The background of the study is that the strategy of early discharge is important from administrative and financial view point, but investigation was also needed to assess whether early discharge had a clinical benefit in terms of improved short-term and long-term outcomes.
As summarized by SCAI, patients undergoing nonaborted TF-TAVR (n = 32,847) and survived to discharge (n = 24,285) in the Transcatheter Valve Therapy (TVT) Registry from 2011 to 2015 were categorized as early discharge (ED; < 72 hours) or delayed discharge (DD). During the study period, there was a significant decline in the rates of DD (2012 Q1, 62.2% vs 2015; Q3, 34.4%).
The study also compared 1-year outcomes based on LOS. Post-TAVR DD was significantly associated with higher 1-year all-cause mortality with separation of curves noted immediately postprocedure. Even after adjusting for in-hospital complications, DD was an independent predictor of 1-year all-cause mortality.
The study investigators advised that the data from their study (predictors) should be prospectively validated within the TVT Registry. Once validated, LOS calculators could help streamline TAVR programs across the world and would help make aortic stenosis care efficient, optimized, and sustainable.
The study for the first time delineates distinct independent predictors of ED/DD (multivariate analysis) and may have a significant impact on the future of care for aortic stenosis patients, noted Siddharth Wayangankar, MD, in the SCAI announcement.
Dr. Wayangankar commented, “The predictors from our study could have a huge impact on future clinical care of TAVR patients. Pre-TAVR, these predictors could be used to develop bedside risk scores for LOS. These could help physicians in patient selection as well as procedural and postprocedural planning based on patient-specific variables. On a much bigger front, these risk scores could be used by administrators, third-party payors and policy makers for formulating coverage for TAVR procedures and evaluating bundle payments.” Dr. Wayangankar further stated that considering the strong association of DD and outcomes at 1 year, patients with DD may require a more rigorous follow-up schedule to mitigate the higher mortality and hospitalization rates.