Relation of Postdischarge Care Fragmentation and Outcomes in Transcatheter Aortic Valve Implantation from the STS/ACC TVT Registry.
Journal Article (Journal Article;Multicenter Study)
Fragmented care following elective surgery has been associated with poor outcomes. The association between fragmented care and outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) is unknown. We examined patients who underwent TAVI from 2011 to 2015 at 374 sites in the STS/ACC TVT Registry, linked to Center for Medicare and Medicaid Services claims data. Fragmented care was defined as at least one readmission to a site other than the implanting TAVI center within 90 days after discharge, whereas continuous care was defined as readmission to the same implanting center. We compared adjusted 1-year outcomes, including stroke, bleeding, heart failure, mortality, and all-cause readmission in patients who received fragmented versus continuous care. Among 8,927 patients who received a TAVI between 2011 and 2015, 27.4% were readmitted within 90 days of discharge. Most patients received fragmented care (57.0%). Compared with the continuous care group, the fragmented care group was more likely to have severe chronic lung disease, cerebrovascular disease, and heart failure. States that had lower TAVI volume per Center for Medicare and Medicaid Services population had greater fragmentation. Patients living > 30 minutes from their TAVI center had an increased risk of fragmented care 1.07 (confidence interval [CI] 1.06 to 1.09, p < 0.001). After adjustment for comorbidities and procedural complications, fragmented care was associated with increased 1-year mortality (hazards ratio 1.18, CI 1.04 to 1.35, p = 0.010) and all-cause readmission (hazards ratio 1.08, CI 1.00 to 1.16, p = 0.051. In conclusion, fragmented readmission following TAVI is common, and is associated with increased 1-year mortality and readmission. Efforts to improve coordination of care may improve these outcomes and optimize long-term benefits yielded from TAVI.
Full Text
Duke Authors
- Douglas, Pamela Susan
- Harrison, John Kevin
- Hughes IV, George Charles
- Kosinski, Andrzej Stanislaw
- Lopes, Renato Delascio
- Rymer, Jennifer Anne
- Sherwood, Matthew William
- Smith, Peter Kent
- Vemulapalli, Sreekanth
Cited Authors
- Wang, A; Li, Z; Rymer, JA; Kosinski, AS; Yerokun, B; Cox, ML; Gulack, BC; Sherwood, MW; Lopes, RD; Inohara, T; Thourani, V; Kirtane, AJ; Holmes, D; Hughes, GC; Harrison, JK; Smith, PK; Vemulapalli, S
Published Date
- September 15, 2019
Published In
Volume / Issue
- 124 / 6
Start / End Page
- 912 - 919
PubMed ID
- 31375245
Electronic International Standard Serial Number (EISSN)
- 1879-1913
Digital Object Identifier (DOI)
- 10.1016/j.amjcard.2019.06.005
Language
- eng
Conference Location
- United States