Non-CV readmissions after TAVR more common among high-risk patients
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High-risk patients undergoing transcatheter aortic valve replacement experienced more readmissions for non-CV causes at 1 year compared with intermediate-risk patients, more than doubling 1-year mortality risk for the high-risk group.
However, readmissions for CV causes after TAVR did not vary between high-risk and intermediate-risk patients, researchers found.
In an analysis of patients who underwent TAVR from 2012 to 2018, researchers found the burden of readmissions after TAVR was significant, with more than 30% of patients experiencing at least one readmission within the first year.
“Understanding the predictors and types of readmissions post‐TAVR will allow for the early identification of at‐risk groups and the implementation of preventative measures to improve outcomes and reduce the burden and costs of readmissions,” Jeffrey A. Southard, MD, an interventional cardiologist and director of the Transcatheter Aortic Valve Replacement Program at UC Davis Health, and colleagues wrote in the study background. “However, data on this topic is scarce and limited predominantly to the high/prohibitive risk group.”
Southard and colleagues analyzed data from 611 patients with severe symptomatic aortic stenosis who underwent TAVR at a single tertiary cardiac institution from January 2012 to June 2018, followed for 1 year (mean age, 81 years; 52.2% men). Researchers assessed CV vs. non-CV causes of readmission, timing and predictors of readmissions, and analyzed readmission impact on clinical outcomes.
Within the cohort, 201 patients experienced 317 readmissions, for a mean of 1.58 per admitted patient (65 patients with at least two readmissions). Among readmitted patients, 64% were for non‐CV causes and 36% were for CV causes. The top three CV causes were pacemaker/implantable cardioverter defibrillator placement, bleeding and stroke.
About 23% of readmissions occurred at 1 month, with most during that period CV-related, whereas 45% of readmissions occurred between months 7 and 12, with most of those non-CV related.
Patients with at least one readmission had a higher burden of comorbidities, including peripheral arterial disease, diabetes, immunosuppression, prior PCI and dialysis. Readmissions were associated with higher 1‐year mortality, with an adjusted HR of 2.53 (95% CI, 1.4-4.59; P = .002). Compared with intermediate-risk patients, high‐risk patients had higher non‐CV readmissions (mean, 0.37 vs. 0.25; P = .044). Risk for CV-related readmissions after TAVR were similar between intermediate- and high-risk groups (P = .645).
“This reemphasizes the point that while TAVR may improve a patient’s valvular issue of aortic stenosis, other comorbidities still play an important role,” the researchers wrote. “Understanding the clinical profile and clarifying the potential causes for readmission will be important toward optimizing preoperative evaluations and implementing cost‐effective health care programs focused on reducing future rehospitalization.”
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