Division of Cardiovascular Medicine, Department of Medicine, University of Toledo Medical Center, Toledo, OH, USA.
Department of Cardiology, Reading Hospital-Tower Health System, West Reading, PA, USA.
Cardiovasc Revasc Med. 2022 Mar;36:1-6. doi: 10.1016/j.carrev.2021.05.019. Epub 2021 May 24.
BACKGROUND/PURPOSE: Home healthcare (HHC) utilization is associated with higher rates of rehospitalization in patients with heart failure and transcatheter mitral valve repair. This study sought to assess the utilization, predictors, and the association of HHC with 30-day readmission in patients undergoing transcatheter aortic valve replacement (TAVR).
METHODS/MATERIALS: We queried the Nationwide Readmission Database from January 2012 to December 2017 for TAVR discharges with and without HHC referral. Using multivariate analysis, we identified predictors of HHC utilization, and its association with outcomes.
Of 60,950 TAVR discharges, 21,724 (35.7%) had HHC referral. On multivariable analysis, female sex (OR, 1.34; 95% CI, 1.29-1.40), non-elective admission (OR, 1.49; 95% CI, 1.42-1.56), diabetes mellitus (OR, 1.09; 95% CI, 1.05-1.13), prior stroke (OR, 1.06; 95% CI, 1.01-1.12), anemia (OR, 1.16; 95% CI, 1.11-1.21), and in-hospital complications including cardiogenic shock (OR, 1.37; 95% CI, 1.16-1.50), cardiac arrest (OR, 1.22; 95% CI, 1.00-1.50), stroke (OR, 2.62; 95% CI, 2.20-3.18), and new Permanent pacemaker (OR, 1.49; 95% CI, 1.41-1.58) were identified as independent predictors of HHC referral. HHC utilization was associated with longer median length of stay (4 days vs. 2 days, P < 0.001), higher rate of 30-day all-cause (15.5% vs. 10.6%, P < 0.001) and heart failure (2.1%vs. 1.1%, P < 0.001) readmission rates compared to those without HHC.
Our study identified a vulnerable group of TAVR patients that are at higher risk of 30-day readmission. Evidence-based interventions proven effective in reducing the burden of readmissions should be pursed in these patients to improve outcomes and quality of life.
背景/目的：家庭医疗保健（HHC）的利用与心力衰竭和经导管二尖瓣修复患者的再住院率较高有关。本研究旨在评估 HHC 的利用情况、预测因素以及与经导管主动脉瓣置换术（TAVR）后 30 天再入院的相关性。
方法/材料：我们从 2012 年 1 月至 2017 年 12 月，从全国再入院数据库中查询了 TAVR 出院患者的 HHC 转介情况。我们使用多变量分析确定了 HHC 利用的预测因素，并评估了其与结局的相关性。
在 60950 例 TAVR 出院患者中，有 21724 例（35.7%）有 HHC 转介。多变量分析显示，女性（比值比[OR]，1.34；95%置信区间[CI]，1.29-1.40）、非择期入院（OR，1.49；95%CI，1.42-1.56）、糖尿病（OR，1.09；95%CI，1.05-1.13）、既往卒史（OR，1.06；95%CI，1.01-1.12）、贫血（OR，1.16；95%CI，1.11-1.21）以及院内并发症，包括心源性休克（OR，1.37；95%CI，1.16-1.50）、心脏骤停（OR，1.22；95%CI，1.00-1.50）、卒史（OR，2.62；95%CI，2.20-3.18）和新的永久性起搏器（OR，1.49；95%CI，1.41-1.58），是 HHC 转介的独立预测因素。与没有 HHC 转介的患者相比，HHC 的使用与更长的中位住院时间（4 天 vs. 2 天，P<0.001）、更高的 30 天全因（15.5% vs. 10.6%，P<0.001）和心力衰竭（2.1% vs. 1.1%，P<0.001）再入院率相关。
我们的研究确定了 TAVR 患者中一个易发生 30 天再入院的脆弱群体。应在这些患者中采取经证实可有效降低再入院负担的循证干预措施，以改善结局和生活质量。
