Department of Interventional Cardiology, Riverside Methodist Hospital-OhioHealth, 3705 Olentangy River Road, Columbus, OH 43214, United States of America.
Department of Interventional Cardiology, St. Vincent's Medical Center, I10590 N Meridian St Fl 2, Indianapolis, IN 46290, United States of America.
Cardiovasc Revasc Med. 2020 Mar;21(3):263-270. doi: 10.1016/j.carrev.2019.05.032. Epub 2019 Jun 10.
BACKGROUND: Predictors of hospital readmissions and tools to predict readmissions after TAVR are scarce. Our objective was to identify predictors of early hospital readmission following TAVR in contemporary clinical practice and develop a risk calculator. METHODS: Patients with a contemporary self-expanding TAVR between 2015 and 2017 in the STS/ACC/TVT Registry™ database were included. Patients were divided into a derivation and validation cohort (2:1). A risk score was calculated using the derivation cohort based on multivariable predictors of 30-day unplanned readmissions and applied to the validation cohort. RESULTS: A total of 10,345 TAVR patients at 350 centers were included. Unplanned 30-day hospital readmission was 9.2%. Patients with an early readmission had higher 30-day rates for mortality (2.3% vs. 0.8%, p ≪ 0.001), stroke (4.1% vs. 2.7% p = 0.009), major vascular complications (2.0% vs. 1.0%, p = 0.003) and new pacemaker implantation (25.7% vs. 18.6%, p ≪ 0.001). Multivariable predictors of 30-day readmission included diabetes, atrial fibrillation, advanced heart failure symptoms, home oxygen, decreased 5-m gait speed or the inability to walk, serum creatinine ≫1.6 mg/dL, index hospitalization length of stay ≫5 days, major vascular complication and ≥ moderate post-procedure aortic or mitral valve regurgitation. Based on these predictors, we stratified 30-day readmission risk into low-, moderate- and high-risk subsets. There was a 2.5× difference in readmission rates between the low- (5.8%) and high-risk subsets (14.6%). CONCLUSION: We stratified the risk of early hospital readmission after TAVR based on a simple scoring system. This score may improve discharge planning centered on the individual's readmission risk. SUMMARY: Unplanned readmissions in the United States are prevalent and costly accounting for $41.3 billion in annual hospital payments and are associated with adverse clinical outcomes. We found that diabetes, atrial fibrillation, advanced heart failure symptoms, home oxygen, frailty, acute kidney injury, prolonged hospitalization, major vascular complications, and moderate or worse post-procedure aortic or mitral valve regurgitation predicted of 30-day readmission following self-expanding TAVR. This information may improve discharge planning centered on each patient's readmission risk.
背景：经导管主动脉瓣置换术（TAVR）后再住院的预测因素和工具仍然缺乏。本研究旨在确定当代临床实践中 TAVR 后早期再住院的预测因素，并开发风险计算器。
方法：纳入 2015 年至 2017 年 STS/ACC/TVT 注册研究数据库中接受现代自膨式 TAVR 的患者。将患者分为推导队列和验证队列（2:1）。根据 30 天计划外再入院的多变量预测因素，在推导队列中计算风险评分，并将其应用于验证队列。
结果：共纳入 350 个中心的 10345 例 TAVR 患者。30 天内非计划性再住院率为 9.2%。早期再入院的患者在 30 天内死亡率（2.3%比 0.8%，p＜0.001）、卒（4.1%比 2.7%，p=0.009）、大血管并发症（2.0%比 1.0%，p=0.003）和新起搏器植入（25.7%比 18.6%，p＜0.001）更高。30 天再入院的多变量预测因素包括糖尿病、心房颤动、晚期心力衰竭症状、家庭吸氧、5 米步行速度下降或无法行走、血清肌酐＞1.6mg/dL、住院时间＞5 天、大血管并发症和/或≥中度术后主动脉瓣或二尖瓣反流。基于这些预测因素，我们将 30 天再入院风险分层为低危、中危和高危亚组。低危（5.8%）和高危亚组（14.6%）的再入院率差异有统计学意义（2.5 倍）。
结论：我们基于一个简单的评分系统对 TAVR 后早期住院再入院的风险进行分层。该评分可能会改善以个体再入院风险为中心的出院计划。
总结：美国未计划再住院的情况普遍存在且费用高昂，占年度医院支付额的 413 亿美元，并与不良临床结局相关。我们发现，糖尿病、心房颤动、晚期心力衰竭症状、家庭吸氧、衰弱、急性肾损伤、住院时间延长、大血管并发症以及中度或以上的术后主动脉瓣或二尖瓣反流与自膨式 TAVR 后 30 天再入院相关。这些信息可能会改善以每个患者再入院风险为中心的出院计划。
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