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Hospital Practice of Direct-Home Discharge and 30-Day Readmission After Transcatheter Aortic Valve Replacement in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (STS/ACC TVT) Registry.

Publication ,  Journal Article
Dodson, JA; Williams, MR; Cohen, DJ; Manandhar, P; Vemulapalli, S; Blaum, C; Zhong, H; Rumsfeld, JS; Hochman, JS
Published in: Journal of the American Heart Association
August 2017

Nearly 17% of patients are readmitted within 30 days of discharge after transcatheter aortic valve replacement. Selected patients are discharged to skilled nursing facilities, yet the association between a hospital's practice to discharge home versus to skilled nursing facilities, and readmission remains unclear.The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (STS/ACC TVT) Registry was used to evaluate readmissions among patients undergoing transcatheter aortic valve replacement (2011-2015). Hospitals were divided into quartiles (Q1-Q4) based on the percentage of patients discharged directly home. We assessed patient and hospital level characteristics and used hierarchical logistic regression to analyze the association of discharge disposition with 30-day readmission. Our cohort included 18 568 transcatheter aortic valve replacement patients at 329 US hospitals, of whom 69% were discharged directly home. Hospitals in the highest quartile of direct home discharge (Q4) compared with hospitals in the lowest (Q1) were more likely to use femoral access (75.2% versus 60.1%, P<0.001), had fewer patients receiving transfusion (26.4% versus 40.9%, P<0.001), and were more likely to be located in the Southern United States (48.8% versus 18.3%, P<0.001). Median 30-day readmission rate was 17.9%. There was no significant difference in 30-day readmissions among quartiles (P=0.14), even after multivariable adjustment (odds ratio Q4 versus Q1=0.89, 95%CI 0.76-1.04; P=0.15). Factors most strongly associated with 30-day readmission were glomerular filtration rate, in-hospital stroke or transient ischemic attack, and nonfemoral access.There was no statistically significant association between hospital practice of direct home discharge post-transcatheter aortic valve replacement and 30-day readmission. Further research is needed to understand regional variations and optimum strategies for postdischarge care.

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Published In

Journal of the American Heart Association

DOI

EISSN

2047-9980

ISSN

2047-9980

Publication Date

August 2017

Volume

6

Issue

8

Start / End Page

e006127

Related Subject Headings

  • United States
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Time Factors
  • Risk Factors
  • Registries
  • Process Assessment, Health Care
  • Patient Readmission
  • Patient Discharge
  • Odds Ratio
 

Citation

APA
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Dodson, J. A., Williams, M. R., Cohen, D. J., Manandhar, P., Vemulapalli, S., Blaum, C., … Hochman, J. S. (2017). Hospital Practice of Direct-Home Discharge and 30-Day Readmission After Transcatheter Aortic Valve Replacement in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (STS/ACC TVT) Registry. Journal of the American Heart Association, 6(8), e006127. https://doi.org/10.1161/jaha.117.006127
Dodson, John A., Mathew R. Williams, David J. Cohen, Pratik Manandhar, Sreekanth Vemulapalli, Caroline Blaum, Hua Zhong, John S. Rumsfeld, and Judith S. Hochman. “Hospital Practice of Direct-Home Discharge and 30-Day Readmission After Transcatheter Aortic Valve Replacement in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (STS/ACC TVT) Registry.Journal of the American Heart Association 6, no. 8 (August 2017): e006127. https://doi.org/10.1161/jaha.117.006127.
Dodson JA, Williams MR, Cohen DJ, Manandhar P, Vemulapalli S, Blaum C, Zhong H, Rumsfeld JS, Hochman JS. Hospital Practice of Direct-Home Discharge and 30-Day Readmission After Transcatheter Aortic Valve Replacement in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (STS/ACC TVT) Registry. Journal of the American Heart Association. 2017 Aug;6(8):e006127.
Journal cover image

Published In

Journal of the American Heart Association

DOI

EISSN

2047-9980

ISSN

2047-9980

Publication Date

August 2017

Volume

6

Issue

8

Start / End Page

e006127

Related Subject Headings

  • United States
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Time Factors
  • Risk Factors
  • Registries
  • Process Assessment, Health Care
  • Patient Readmission
  • Patient Discharge
  • Odds Ratio