Trends, Predictors, and Outcomes of 30‐Day Readmission With Heart Failure After Transcatheter Aortic Valve Replacement: Insights From the US Nationwide Readmission Database

Abstract

BACKGROUND Data on trends, predictors, and outcomes of heart failure (HF) readmissions after transcatheter aortic valve replacement (TAVR) remain limited. Moreover, the relationship between hospital TAVR discharge volume and HF readmission outcomes has not been established. METHODS AND RESULTS The Nationwide Readmission Database was used to identify 30‐day readmissions for HF after TAVR from October 1, 2015, to November 30, 2018, using International Classification of Diseases, Tenth Revision, Clinical Modification ( ICD‐10‐CM ) codes. A total of 167 345 weighted discharges following TAVR were identified. The all‐cause readmission rate within 30 days of discharge was 11.4% (19 016). Of all the causes of 30‐day rehospitalizations, HF comprised 31.4% (5962) of all causes. The 30‐day readmission rate for HF did not show a significant decline during the study period ( P trend =0.06); however, all‐cause readmission rates decreased significantly ( P trend =0.03). HF readmissions were comparable between high‐ and low‐volume TAVR centers. Charlson Comorbidity Index >8, length of stay >4 days during the index hospitalization, chronic obstructive pulmonary disease, atrial fibrillation, chronic HF, preexisting pacemaker, complete heart block during index hospitalization, paravalvular regurgitation, chronic kidney disease, and end‐stage renal disease were independent predictors of 30‐day HF readmission after TAVR. HF readmissions were associated with higher mortality rates when compared with non‐HF readmissions (4.9% versus 3.3%; P <0.01). Each HF readmission within 30 days was associated with an average increased cost of $13 000 more than for each non‐HF readmission. CONCLUSIONS During the study period from 2015 to 2018, 30‐day HF readmissions after TAVR remained steady despite all‐cause readmissions decreasing significantly. All‐cause readmission mortality and HF readmission mortality also showed a nonsignificant downtrend. HF readmissions were comparable across low‐, medium‐, and high‐volume TAVR centers. HF readmission was associated with increased mortality and resource use attributed to the increased costs of care compared with non‐HF readmission. Further studies are needed to identify strategies to decrease the burden of HF readmissions and related mortality after TAVR.

Readmissions After Left Atrial Appendage Closure in Patients With Previous Ischemic Stroke or Transient Ischemic Attack

“…The observed 8.2% readmission rate at 30 days is slightly lower than that reported in previous studies, in which the overall 30-day readmission rate was 9.4%. 16 , 17 Moreover, the rates were lower than those reported for other catheter-based cardiac procedures, including catheter ablation for atrial fibrillation (11%), 18 , 19 transcatheter aortic valve implantation (11%), 20 and transcatheter edge-to-edge mitral valve repair (14%-16%). 21 , 22 …”

Rates, predictors, and causes of readmission after transcatheter aortic valve replacement in patients with chronic kidney disease

“…The prevalence of heart failure in patients with AS is estimated at 10% and represents the sole most common cause of readmissions post-TAVR[ 25 , 26 ] . Systolic dysfunction, as measured by stress-corrected midwall shortening, is an unfavorable prognostic factor in AS.…”

Development of In-Hospital Outcomes in Patients undergoing Transcatheter Aortic Valve Implantation (TAVI) at an Interdisciplinary Heart Center: A Single-Center Experience of 489 Consecutive Cases

“…Atrial fibrillation was another patient-related predictor of hospital mortality that could be identified in multivariate regression analysis. Although the underlying mechanism for in-hospital mortality remains unclear in this study, the relevance of this comorbidity is indisputable, as there is evidence that patients with atrial fibrillation are at higher risk of rehospitalization due to heart failure after TAVI [ 13 ]. Given the fact that there was no follow-up of the patients in this study, we cannot provide further information about rehospitalizations due to heart failure.…”