Author + information
- Received October 4, 2018
- Revision received November 13, 2018
- Accepted November 14, 2018
- Published online March 4, 2019.
- Siddharth A. Wayangankar, MDa,∗ (, )
- Islam Y. Elgendy, MDa,
- Qun Xiang, MSb,
- Hani Jneid, MDc,
- Sreekanth Vemulapalli, MDb,
- Tigran Khachatryan, MDd,
- Don Pham, MDe,
- Anthony A. Hilliard, MDd and
- Samir R. Kapadia, MDf
- aDivision of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida
- bDuke Cardiovascular Research Institute, Durham, North Carolina
- cDivision of Cardiovascular Medicine, Baylor College of Medicine, Houston, Texas
- dDivision of Cardiovascular Medicine, Loma Linda University, Loma Linda, California
- eMemorial Hermann Hospital, Houston, Texas
- fDepartment of Cardiology, Cleveland Clinic, Cleveland, Ohio
- ↵∗Address for correspondence:
Dr. Siddharth A. Wayangankar, Division of Cardiovascular Medicine, Department of Medicine, University of Florida, 7919 SW 79th Drive, Gainesville, Florida 32610.
Objectives The goal of this study was to investigate the trends, predictors, and outcomes of delayed discharge (>72 h) after transcatheter aortic valve replacement.
Background Length of stay post–transcatheter aortic valve replacement may have significant clinical and administrative implications.
Methods Data from the Transcatheter Valve Therapy Registry were used to identify patients undergoing nonaborted transfemoral transcatheter aortic valve replacement who survived to discharge, and data linked from the Centers for Medicare & Medicaid Services were used to provide 1-year events. Patients were categorized to early discharge (≤72 h) versus delayed discharge (>72 h). The trends, predictors, and adjusted 1-year outcomes were compared in both groups.
Results From 2011 to 2015, a total of 13,389 patients (55.1%) were discharged within 72 h, whereas 10,896 patients (44.9%) were discharged beyond 72 h. There was a significant decline in rates of delayed discharge across the study period (62% vs. 34%; p < 0.01). This remained unchanged when stratified by Transcatheter Valve Therapy risk scores. Several factors were identified as independent predictors of early and delayed discharge. After adjustment for in-hospital complications, delayed discharge was an independent predictor of 1-year all-cause mortality (hazard ratio: 1.45; 95% confidence interval: 1.30 to 1.60; p < 0.01).
Conclusions Rates of delayed discharge have declined from 2011 to 2015. Delayed discharge is associated with a significant increase in mortality even after adjusting for in-hospital complications. Further work is necessary to determine if predictors of early discharge could be used to develop length of stay scores that might be instrumental in administrative, financial, or clinical policy development.
Dr. Wayangankar is a proctor for Medtronic Valve therapies. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 4, 2018.
- Revision received November 13, 2018.
- Accepted November 14, 2018.
- 2019 American College of Cardiology Foundation
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