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Can J Cardiol. 2019 Feb;35(2):199-207. doi: 10.1016/j.cjca.2018.11.035. Epub 2018 Dec 12.

Impact of Discharge Location After Transcatheter Aortic Valve Replacement on 1-Year Outcomes in Women: Results From the WIN-TAVI Registry.

Author information

1
Munich University Clinic, Ludwig-Maximilians-University and German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany.
2
Icahn School of Medicine at Mount Sinai, New York, New York, USA.
3
San Raffaele Scientific Institute, Milan, Italy.
4
AOUP Cisanello, University Hospital, Pisa, Italy.
5
Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé, Massy, France.
6
Istituto Clinico Humanitas, Milan, Italy.
7
University of Catania, Catania, Italy.
8
Clinique Pasteur, Toulouse, France.
9
Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy.
10
Policlinico "Umberto I", "Sapienza" University of Rome, Rome, Italy.
11
Erasmus Medical Center, Thorax center, Rotterdam, The Netherlands.
12
Mauriziano Hospital, Turin, Italy.
13
Rangueil University Hospital, Toulouse, France.
14
University of Padova, Padova, Italy.
15
Centro Cardiologico Monzino, Milan, Italy.
16
Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom.
17
Mount Sinai Hospital, New York, New York, USA.
18
Hospital Universitario Miguel Servet, Zaragoza, Spain.
19
Contilia Heart and Vascular Centre, Elisabeth Krankenhaus, Essen, Germany.
20
Radboud University Nijmegen Medical Center, The Netherlands.
21
Icahn School of Medicine at Mount Sinai, New York, New York, USA. Electronic address: Roxana.mehran@mountsinai.org.

Abstract

BACKGROUND:

Several clinical and procedural factors determine outcomes after transcatheter aortic valve replacement (TAVR), but data are scarce on the impact of post-TAVR discharge disposition on long-term outcomes. We sought to analyse whether discharge location after TAVR is associated with 1-year outcomes in women undergoing contemporary TAVR.

METHODS:

The Women's INternational Transcatheter Aortic Valve Implantation (WIN-TAVI) registry is the first all-female TAVR registry to study the safety and performance of contemporary TAVR in women (n = 1019). Information on discharge location was available in 817 patients (80.2%). We compared women discharged home vs those discharged to another location (nursing home, rehabilitation, or other hospital). One-year outcomes were adjusted using multivariable Cox regression methods with discharge home as the reference group.

RESULTS:

Of the study subjects, 75.2% (n = 614) were discharged home and 24.8% (n = 203) to another location. Women discharged to other locations were older with a greater prevalence of severe lung disease requiring home oxygen and renal failure on dialysis but were less frequently considered frail or at high surgical risk compared with women discharged home. After multivariable adjustment, non-home discharge was associated with greater hazard for 1-year Valve Academic Research Consortium 2 efficacy (21.3% vs 10.8%, hazards ratio [HR] 1.9, 95% confidence interval [CI] 1.2-2.9) and safety endpoints (31.5% vs 15.2%, HR 2.1, 95% CI 1.5-3.0), cardiovascular death (12.7% vs 5.5%, HR 2.0, 95% CI 1.1-3.6), and stroke (6.5% vs 0.8%, HR 8.5, 95% CI 2.9-25.6).

CONCLUSIONS:

In women undergoing contemporary TAVR, discharge disposition significantly affects 1-year risk of outcomes even after adjustment for recorded baseline differences. This might suggest the necessity of considering additional factors beyond comorbidities in the TAVR decision-making process.

PMID:
30760427
DOI:
10.1016/j.cjca.2018.11.035

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