Early discharge after TAVR ‘reasonable,’ does not affect readmission for pacemaker implant
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In patients who did not require permanent pacemaker implantation during hospitalization for transcatheter aortic valve replacement, the readmission rate for a permanent pacemaker implant was similar with early vs. late discharge, data show.
Data show that early discharge after TAVR, defined as same day or next day, has increased in the United States and is associated with lower cost of hospitalization, Marwan Saad, MD, PhD, FACC, FSCAI, FESC, director of interventional structural heart research at the Lifespan Cardiovascular Institute and assistant professor of medicine at the Warren Alpert Medical School of Brown University, told Healio. Additionally, among TAVR patients who did not require in-hospital permanent pacemaker implantation after the procedure, the rate of readmission for permanent pacemaker implantation is approximately 2% and occurred within approximately 2 weeks after the index procedure.
“The study suggests that in patients who do not develop electrocardiographic changes requiring permanent pacemaker implantation after TAVR, early discharge is reasonable, and extended time of telemetry observation does not necessarily reduce the rate or median time of readmission for permanent pacemaker implantation,” Saad told Healio.
Saad and colleagues examined rates of readmission for permanent pacemaker implantation with early vs. late discharge after TAVR for 68,482 patients, using data from the Nationwide Readmission Database 2016-2018. Researchers stratified hospitalizations into early (days 0 and 1) vs. late (2 days) discharge groups, excluding any cases where permanent pacemaker implantation was required during the index admission. Primary outcome was 90‐day readmission for permanent pacemaker implantation.
The findings were published in Catheterization & Cardiovascular Interventions.
Within the cohort, 29.6% of cases were early discharge and 70.4% were late discharge. However early discharge after TAVR increased during the study period, from 16.2% in 2016 to 37.9% in 2018 (P for trend < .01), whereas 90‐day readmission for permanent pacemaker implantation remained stable, at 1.8% in 2016 vs. 2% in 2018 (P for trend = .32).
The 90‐day readmission rate for a permanent pacemaker implant was 2% with early discharge and 1.8% with late discharge, for an adjusted OR of 1.15 (95% CI, 0.95-1.39; P = .15). Median time‐to‐readmission was 5 days for both early- and late-discharge groups (P = .92). Results persisted in analyses assessing whether the TAVR procedure was elective or not.
Early discharge was also associated with lower mean hospitalization cost, at $39,990 vs. $46,750 (adjusted mean difference, –$4,943; 95% CI, –6,558 to –3,329; P < .01) compared with late discharge.
“As a minimalistic TAVR approach is becoming the standard of care, it would be ideal to see larger, randomized controlled trials that confirm the observations and identify precise patient criteria in whom early — especially same-day — discharge is safe,” Saad told Healio.
For more information:
Marwan Saad, MD, PhD, FACC, FSCAI, FESC, can be reached at marwanssaad@gmail.com; Twitter: @MarwanSaadMD.
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