Skip to main content
Journal cover image

Relation of Postdischarge Care Fragmentation and Outcomes in Transcatheter Aortic Valve Implantation from the STS/ACC TVT Registry.

Publication ,  Journal Article
Wang, A; Li, Z; Rymer, JA; Kosinski, AS; Yerokun, B; Cox, ML; Gulack, BC; Sherwood, MW; Lopes, RD; Inohara, T; Thourani, V; Kirtane, AJ ...
Published in: Am J Cardiol
September 15, 2019

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.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

September 15, 2019

Volume

124

Issue

6

Start / End Page

912 / 919

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Survival Rate
  • Risk Factors
  • Retrospective Studies
  • Registries
  • Prognosis
  • Process Assessment, Health Care
  • Patient Readmission
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Wang, A., Li, Z., Rymer, J. A., Kosinski, A. S., Yerokun, B., Cox, M. L., … Vemulapalli, S. (2019). Relation of Postdischarge Care Fragmentation and Outcomes in Transcatheter Aortic Valve Implantation from the STS/ACC TVT Registry. Am J Cardiol, 124(6), 912–919. https://doi.org/10.1016/j.amjcard.2019.06.005
Wang, Alice, Zhuokai Li, Jennifer A. Rymer, Andrzej S. Kosinski, Babatunde Yerokun, Morgan L. Cox, Brian C. Gulack, et al. “Relation of Postdischarge Care Fragmentation and Outcomes in Transcatheter Aortic Valve Implantation from the STS/ACC TVT Registry.Am J Cardiol 124, no. 6 (September 15, 2019): 912–19. https://doi.org/10.1016/j.amjcard.2019.06.005.
Wang A, Li Z, Rymer JA, Kosinski AS, Yerokun B, Cox ML, et al. Relation of Postdischarge Care Fragmentation and Outcomes in Transcatheter Aortic Valve Implantation from the STS/ACC TVT Registry. Am J Cardiol. 2019 Sep 15;124(6):912–9.
Wang, Alice, et al. “Relation of Postdischarge Care Fragmentation and Outcomes in Transcatheter Aortic Valve Implantation from the STS/ACC TVT Registry.Am J Cardiol, vol. 124, no. 6, Sept. 2019, pp. 912–19. Pubmed, doi:10.1016/j.amjcard.2019.06.005.
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. Relation of Postdischarge Care Fragmentation and Outcomes in Transcatheter Aortic Valve Implantation from the STS/ACC TVT Registry. Am J Cardiol. 2019 Sep 15;124(6):912–919.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

September 15, 2019

Volume

124

Issue

6

Start / End Page

912 / 919

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Survival Rate
  • Risk Factors
  • Retrospective Studies
  • Registries
  • Prognosis
  • Process Assessment, Health Care
  • Patient Readmission