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

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
Source :
The American journal of cardiology [Am J Cardiol] 2019 Sep 15; Vol. 124 (6), pp. 912-919. Date of Electronic Publication: 2019 Jun 27.
Publication Year :
2019

Abstract

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.<br /> (Copyright © 2019 Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1879-1913
Volume :
124
Issue :
6
Database :
MEDLINE
Journal :
The American journal of cardiology
Publication Type :
Academic Journal
Accession number :
31375245
Full Text :
https://doi.org/10.1016/j.amjcard.2019.06.005