Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, China.
Zhejiang Provincial People's Hospital, Hangzhou, China.
Herz. 2021 Apr;46(Suppl 1):1-8. doi: 10.1007/s00059-019-04870-6. Epub 2019 Dec 5.
BACKGROUND: Since readmission rate is an important clinical index to determine the quality of inpatient care and hospital performance, the aim of this study was to explain the causes and predictors of readmission following transcatheter aortic valve implantation (TAVI) at short-term and mid-term follow-up. METHODS AND RESULTS: A systematic review and meta-analysis of all published articles from Embase, Pubmed/MEDLINE, and Ovid was carried out. In all, 10 studies including 52,702 patients were identified. The pooled estimate for the overall event rate was 0.15, and cardiovascular causes were the main reason for 30-day readmission (0.42, 95% confidence interval [CI]: 0.39-0.45). In addition, the pooled incidence of 1‑year readmission was 0.31, and cardiovascular events were still the main cause (0.41, 95% CI: 0.33-0.48). Patients with major and life-threatening bleeding, new permanent pacemaker implantation, and clinical heart failure were associated with a high risk for early readmission after TAVI. Moreover, an advanced (≥3) New York Heart Association classification, acute kidney injury, paravalvular leak, mitral regurgitation (≥ moderate), and major bleeding predicted unfavorable outcome to 1‑year readmission. Female gender and transfemoral TAVI was associated with a lower risk for unplanned rehospitalization. CONCLUSIONS: This meta-analysis found cardiovascular factors to be the main causes for both 30-day and 1‑year rehospitalization. Heart failure represented the most common cardiovascular event at both short-term and mid-term follow-up. Several baseline characteristics and procedure-related factors were deemed unfavorable predictors of readmission. Importantly, transfemoral access and female gender were associated with a lower risk of readmission.
背景:由于再入院率是衡量住院患者护理质量和医院绩效的重要临床指标,因此本研究旨在解释经导管主动脉瓣置换术(TAVI)后短期和中期随访时再入院的原因和预测因素。
方法和结果:对 Embase、Pubmed/MEDLINE 和 Ovid 中所有已发表文章进行了系统评价和荟萃分析。共纳入 10 项研究,总计 52702 例患者。汇总估计的总体事件发生率为 0.15,心血管原因是 30 天再入院的主要原因(0.42,95%置信区间[CI]:0.39-0.45)。此外,1 年再入院的累积发生率为 0.31,心血管事件仍然是主要原因(0.41,95%CI:0.33-0.48)。TAVI 后早期再入院风险较高的患者包括有重大和危及生命的出血、新植入永久性起搏器和临床心力衰竭。此外,纽约心脏协会(NYHA)分级较高(≥3)、急性肾损伤、瓣周漏、二尖瓣反流(≥中度)和大出血预测 1 年再入院的不良预后。女性和经股 TAVI 与计划外再住院的风险降低相关。
结论:本荟萃分析发现心血管因素是 30 天和 1 年再入院的主要原因。心力衰竭是短期和中期随访时最常见的心血管事件。一些基线特征和手术相关因素被认为是再入院的不利预测因素。重要的是,经股入路和女性与较低的再入院风险相关。
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