Department of Medicine Rochester General Hospital Rochester NY.
Department of Internal Medicine Allegheny Health Network Pittsburgh PA.
J Am Heart Assoc. 2022 Aug 16;11(16):e024890. doi: 10.1161/JAHA.121.024890. Epub 2022 Aug 5.
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 () 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 (=0.06); however, all-cause readmission rates decreased significantly (=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%; <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.
经导管主动脉瓣置换术（TAVR）后心力衰竭（HF）再入院的趋势、预测因素和结局数据仍然有限。此外，医院 TAVR 出院量与 HF 再入院结局之间的关系尚未确定。
利用全国再入院数据库，使用（）代码，于 2015 年 10 月 1 日至 2018 年 11 月 30 日，确定 TAVR 后 30 天内因 HF 再入院的患者。共确定 167345 例 TAVR 后的加权出院病例。出院后 30 天内全因再入院率为 11.4%（19016 例）。在所有 30 天内再住院的原因中，HF 占所有原因的 31.4%（5962 例）。在研究期间，HF 的 30 天再入院率没有显著下降（=0.06）；然而，全因再入院率显著下降（=0.03）。HF 再入院在高容量和低容量 TAVR 中心之间无差异。Charlson 合并症指数>8、住院期间住院时间>4 天、慢性阻塞性肺疾病、心房颤动、慢性 HF、永久性起搏器、住院期间完全性心脏阻滞、瓣周漏、慢性肾脏病和终末期肾病是 TAVR 后 30 天 HF 再入院的独立预测因素。与非 HF 再入院相比，HF 再入院的死亡率更高（4.9%比 3.3%；<0.01）。与非 HF 再入院相比，HF 再入院 30 天内的平均费用增加了 13000 美元以上。
在 2015 年至 2018 年的研究期间，尽管全因再入院率显著下降，但 TAVR 后 30 天 HF 再入院率仍保持稳定。全因再入院死亡率和 HF 再入院死亡率也呈下降趋势，但无统计学意义。低、中、高容量 TAVR 中心之间 HF 再入院率相当。HF 再入院与死亡率增加和资源使用增加有关，这归因于护理成本的增加，与非 HF 再入院相比。需要进一步研究以确定降低 TAVR 后 HF 再入院率和相关死亡率的策略。
