Study Shows Relation Between Postdischarge Care Fragmentation and Worse Outcomes in TAVR
July 9, 2019—Findings from a study of the fragmentation of postdischarge care after transcatheter aortic valve replacement (TAVR) were published online by Alice Wang, MD, et al in American Journal of Cardiology.
The study was composed of patients who underwent TAVR from 2011 to 2015 at 374 sites in the STS/ACC TVT registry, linked to Centers for Medicare & Medicaid Services (CMS) claims data. Fragmented care was defined as ≥ one readmission to a site other than the implanting TAVR center within 90 days of discharge, whereas continuous care was defined as readmission to the same implanting center.
In American Journal of Cardiology, the investigators reported that among the 8,927 patients who underwent TAVR between 2011 and 2015, 27.4% were readmitted within 90 days of discharge. Most patients received fragmented care (57%). Patients in the fragmented care group were more likely to have severe chronic lung disease, cerebrovascular disease, and heart failure than patients in the continuous care group.
The study compared adjusted 1-year outcomes including stroke, bleeding, heart failure, mortality, and all-cause readmission in patients who received fragmented care versus patients who received continuous care.
The investigators found that states that had lower TAVR volume per CMS population had greater fragmentation. Patients living > 30 minutes from their TAVR center had an odds ratio of 1.07 of experiencing fragmented care (confidence interval [CI], 1.06–1.09; P < .001). After adjustment for comorbidities and procedural complications, fragmented care was associated with increased 1-year mortality (hazard ratio [HR], 1.18; CI, 1.04–1.35; P = .01) and all-cause readmission (HR, 1.08; CI, 1–1.16; P = .051).
The findings demonstrated that fragmented readmission after TAVR is common and associated with increased 1-year mortality and readmission. Efforts to improve coordination of care may improve these outcomes and optimize long-term benefits yielded from TAVR, concluded the investigators in American Journal of Cardiology.