Article Text

Download PDFPDF
Identifying patients likely to be readmitted after transcatheter aortic valve replacement
  1. Andrew Goldsweig1,
  2. Herbert David Aronow2,3
  1. 1Department of Cardiovascular Medicine, University of Nebraska Medical Center College of Medicine, Omaha, Nebraska, USA
  2. 2Department of Cardiovascular Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
  3. 3Cardiovascular Institute, Lifespan Health System, Providence, Rhode Island, USA
  1. Correspondence to Dr Andrew Goldsweig, Cardiovascular Medicine, University of Nebraska Medical Center College of Medicine, Omaha, Nebraska, USA; andrew.goldsweig{at}unmc.edu

Abstract

Hospital readmission following transcatheter aortic valve replacement (TAVR) contributes considerably to the costs of care. Readmission rates following TAVR have been reported to be as high as 17.4% at 30 days and 53.2% at 1 year. Patient and procedural factors predict an increased likelihood of readmission including non-transfemoral access, acute and chronic kidney impairment, chronic lung disease, left ventricular systolic dysfunction, atrial fibrillation, major bleeding and prolonged index hospitalisation. Recent studies have also found the requirement for new pacemaker implantation and the severity of paravalvular aortic regurgitation and tricuspid regurgitation to be novel predictors of readmission. Post-TAVR readmission within 30 days of discharge is more likely to occur for non-cardiac than cardiac pathology, although readmission for cardiac causes, especially heart failure, predicts higher mortality than readmission for non-cardiac causes. To combat the risk of readmission and associated mortality, the routine practice of calculating and considering readmission risk should be adopted by the heart team. Furthermore, because most readmissions following TAVR occur for non-cardiac reasons, more holistic approaches to readmission prevention are necessary. Familiarity with the most common predictors and causes of readmission should guide the development of initiatives to address these conditions proactively.

  • transcatheter valve interventions
  • aortic stenosis
  • health care delivery
  • quality and outcomes of care
View Full Text

Statistics from Altmetric.com

Footnotes

  • Twitter @agoldsweig, @herbaronowMD

  • Contributors Both authors participated in the writing of this review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.