Data show HF readmissions after TAVR ‘remain steady’ across centers
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A database analysis of hospital readmissions after transcatheter aortic valve replacement show HF readmissions have remained steady over 3 years across low- and high-volume TAVR centers, despite an overall decline in all-cause readmissions.
“The most striking finding we observed is one in three readmissions after TAVR are attributed to HF,” Salman Zahid, MD, a resident physician at Rochester General Hospital in New York, told Healio. “Patients who are readmitted with HF after TAVR have higher mortality rates as well as higher resource utilization, in terms of increased length of stay and increased cost. This signifies that this is a significant burden.”
Zahid and colleagues analyzed data from 167,345 patients with readmissions within 30 days after TAVR from October 2015 through November 2018, using the National Readmission Database. The primary outcome was 30-day readmissions for HF after TAVR discharge. Secondary outcomes included predictors of HF readmissions, temporal trends, in-hospital complications related to HF readmissions compared with non-HF readmissions, the association of readmissions with hospital TAVR discharge volume and resource use in terms of adjusted hospitalization cost for HF readmissions and non-HF readmissions.
The findings were published in the Journal of the American Heart Association.
The all-cause readmission rate within 30 days of discharge was 11.4%. HF comprised 31.4% of all causes of 30-day rehospitalizations. The 30-day readmission rate for HF did not decline significantly during the study period (P for trend = .06); however, all-cause readmission rates decreased (P for trend = .03).
Researchers found that HF readmissions were comparable between high- and low-volume TAVR centers.
“All-cause readmission rates after TAVR showed a significant downtrend, whereas HF rehospitalizations remained steady,” the researchers wrote.
Independent predictors of 30-day HF readmission after TAVR were Charlson Comorbidity Index score of 8 or greater, a length of stay of at least 4 days during the index hospitalization, chronic obstructive pulmonary disease, atrial fibrillation, chronic HF, preexisting pacemaker, complete heart block during index hospitalization, paravalvular regurgitation, chronic kidney disease and end-stage renal disease.
“We found significant predictors of HF readmission, such as high comorbidity burden, the length of stay greater than 4 days during the index admission, a history of preexisting HF, someone with CKD — those are the patients at increased risk for HF,” Zahid told Healio. “These patients need to be the focus of intervention after TAVR, with a dedicated HF team to reduce the readmission rates. We also show the readmission rates have not decreased while other outcomes have improved.”
Additionally, HF readmissions were associated with higher mortality rates compared with non-HF readmissions (4.9% vs. 3.3%; P < .01). Each HF readmission within 30 days was associated with an average cost of $13,000 more compared with each non-HF readmission within 30 days.
“We need studies evaluating approaches to reduce the burden of HF hospitalizations after TAVR,” Sudarshan Balla, MD, FACC, FSCMR, associate professor of medicine and program director of Cardiovascular Disease Fellowship at West Virginia University, told Healio. “A more in-depth look with granular data can help us understand the reasons why some patients get readmitted with HF after TAVR.”
For more information:
Sudarshan Balla, MD, FACC, FSCMR, can be reached at sudarshan.balla@wvumedicine.org; Twitter: @sudarshanballa.
Salman Zahid, MD, can be reached at salmannazar1312@gmail.com; Twitter: @salmanzahidmd.
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