Discharge Location and Outcomes after Transcatheter Aortic Valve Implantation.

Sweda, Romy; Dobner, Stephan; Heg, Dik; Lanz, Jonas; Malebranche, Daniel; Langhammer, Bettina; Okuno, Taishi; Praz, Fabien; Räber, Lorenz; Valgimigli, Marco; Reineke, David Christian; Pilgrim, Thomas; Windecker, Stephan; Stortecky, Stefan (2021). Discharge Location and Outcomes after Transcatheter Aortic Valve Implantation. American journal of cardiology, 140, pp. 95-102. Elsevier 10.1016/j.amjcard.2020.10.058

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The relationship between discharge location and outcomes after transcatheter aortic valve implantation (TAVI) is largely unknown. Thus, the objective of this study was to investigate the impact of discharge location on clinical outcomes after TAVI. Between August 2007 and December 2018, consecutive patients undergoing transfemoral TAVI at Bern University Hospital were grouped according to discharge location. Clinical adverse events were adjudicated according to VARC-2 endpoint definitions. Of 1,902 eligible patients, 520 (27.3%) were discharged home, 945 (49.7%) were discharged to a rehabilitation clinic and 437 (23.0%) were transferred to another institution. Compared with patients discharged to a rehabilitation facility or another institution, patients discharged home were younger (80.8±6.5 vs. 82.9±5.4 and 82.8±6.4 years), less likely female (37.3% vs. 59.7% and 54.2%) and at lower risk according to STS-PROM (4.5±3.0% vs. 5.5±3.8% and 6.6±4.4%). At 1 year follow-up, patients discharged home had similar rates of all-cause mortality (HRadj 0.82; 95%CI 0.54-1.24), cerebrovascular events (HRadj 1.04; 95%CI 0.52-2.08) and bleeding complications (HRadj 0.93; 95%CI 0.61-1.41) compared to patients discharged to a rehabilitation facility. Patients discharged home or to rehabilitation were at lower risk for death (HRadj 0.37; 95%CI 0.24-0.56 and HRadj 0.44; 95%CI 0.32-0.60) and bleeding (HRadj 0.48; 95%CI 0.30-0.76 and HRadj 0.66; 95%CI 0.45-0.96) during the first year after hospital discharge compared to patients transferred to another institution. In conclusion, discharge location is associated with outcomes after TAVI with patients discharged home or to a rehabilitation facility having better clinical outcomes than patients transferred to another institution. Clinical Trial Registration: https://www.clinicaltrials.gov. NCT01368250.

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