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Wait time before TAVR may be unrelated to 30-day outcomes
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There was a significant nonlinear relationship between the amount of time patients waited to undergo transcatheter aortic valve replacement and the rate of mortality and readmission at 30 days after the procedure, according to a study published in the Journal of the American Heart Association.
Gabby Elbaz-Greener, MD, of the division of cardiology and cardiac surgery at Schulich Heart Centre at Sunnybrook Health Sciences Center at University of Toronto, and colleagues analyzed data from 2,170 patients (mean age, 82 years; 46% women) from the CorHealth Ontario TAVR Registry who underwent TAVR between April 2010 and March 2016.
Total TAVR wait time was defined as the time from referral date to the date the patient underwent TAVR. The status of the procedure was categorized as urgent (n = 429) or elective (n = 1,741).
The primary outcomes of interest were all-cause readmission and all-cause mortality 30 days after TAVR.
The mean wait time for TAVR was 132.5 days. Within 30 days after TAVR, 6.9% died and 15.6% were readmitted to the hospital. Compared with the elective group, the urgent group had higher rates of 30-day mortality (11.4% vs. 5.7%; P < .001) and 30-day readmission (20.3% vs. 14.5%; P = .003).
The relationship between mortality and wait times was both statistically significant (P < .001) and nonlinear (P < .08). This was also seen for all-cause readmission at 30 days after TAVR (P = .01 for overall relationship; P = .06 for linearity). The relationship between wait times and both mortality and readmission persisted after adjusting for clinical variables.
Wait time was not associated with either 30-day readmission (HR = 1; 95% CI, 0.99-1) or 30-day mortality (HR = 0.99; 95% CI, 0.99-1) in patients in the elective TAVR group. This was also seen in patients in the urgent group regarding 30-day readmission (HR = 1; 95% CI, 0.99-1.01) and 30-day mortality (HR = 1; 95% CI, 0.99-1.01).
“This is a critical insight that has implications for TAVR wait-time management,” Elbaz-Greener and colleagues wrote. “Although several risk models have been developed to predict postprocedure mortality in patients undergoing TAVR to improve patient selection, no risk models exist to triage patients on the basis of their level of risk for adverse events while on the waitlist. Our results suggest that research on preprocedural queuing and triage should focus on how to better identify patients who may deteriorate to the point of requiring in-hospital TAVR.” – by Darlene Dobkowski
Disclosures: Elbaz-Greener reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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