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Observational Study
. 2019 Jan 18;19(1):23.
doi: 10.1186/s12872-019-1003-9.

Association between transitional care factors and hospital readmission after transcatheter aortic valve replacement: a retrospective observational cohort study

Andrew Czarnecki  1   2   3 , Peter C Austin  4   5 , Stephen E Fremes  6   4 , Jack V Tu  6   7   4   5 , Harindra C Wijeysundera  6   7   4   5 , Dennis T Ko  6   7   4   5
Affiliations
Observational Study

Association between transitional care factors and hospital readmission after transcatheter aortic valve replacement: a retrospective observational cohort study

Andrew Czarnecki et al. BMC Cardiovasc Disord. .

Abstract

Background: Studies have shown that patients who undergo trans-catheter aortic valve replacement (TAVR) have high rates of hospital readmission. Our objectives were to identify the causes of readmission after TAVR, determine whether transitional care factors were associated with a reduction in readmission and to identify other predictors that could be used to target quality improvement efforts.

Methods: We conducted a chart abstraction study that included all patients who underwent TAVR in Ontario, Canada between 2007 and 2013 and survived to hospital discharge. These data were linked to provincial administrative databases. The association between transitional care factors (home care, rehabilitation, family physician and cardiologist follow-up) and 1-year hospital readmission was examined using a time-to-event analysis. Cause-specific hazards models were used to account for the competing risk of death.

Results: There were 937 patients in the cohort and the rate of readmission at 1-year was 49%. The most common causes of readmission were heart failure and bleeding. Rehabilitation (HR 1.34, 95% CI 1.11-1.62; p = 0.002) and cardiologist follow-up (HR 1.41, 95% CI 1.14-1.75; p = 0.002) were both associated with higher readmission rates. While, home care (HR 1.18, 95% CI 0.96-1.44; p = 0.12) and family physician follow-up (HR 1.04, 95% CI 0.85-1.28; p = 0.71) were not associated with readmission.

Conclusion: Readmission post TAVR is common; however, we did not identify any transitional care factors associated with reductions in hospital readmission. This suggests ongoing research is required to identify targets for improvement in post-procedural care.

Keywords: Aortic stenosis; Hospital readmission; Transcatheter aortic valve replacement; Transition of care.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the institutional review board at Sunnybrook Health Sciences Centre, Toronto, Canada. Local hospital ethics board approval was obtained at each of the 10 hospitals performing TAVR in Ontario at the time of the study. Based on Ontario’s Privacy Legislation, the need for individual patient consent was waived.

Consent for publication

Not applicable.

Competing interests

Dr. Wijeysundera received research funding from Medtronic Inc. and Edwards Lifesciences. The remaining authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study cohort creation
Fig. 2
Fig. 2
Cumulative incidence curves for readmission and death without readmission. Readmission is shown in blue and death is shown in orange
Fig. 3
Fig. 3
Diagnoses of patients readmitted within 1-year of TAVR. Readmission diagnoses based on most-responsible diagnosis in the year following the index TAVR hospitalization (red bars represent cardiac diagnoses and blue bars represent non-cardiac diagnoses)
See this image and copyright information in PMC

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