The risk of a patient's unplanned hospital readmission within 30 days following discharge after a self-expanding TAVR procedure can be calculated using a scoring system based on the patient's comorbidities, condition and treatment. The risk calculator could be used to improve discharge planning, according to the study published in Cardiovascular Research Medicine.

Carlos E. Sanchez, MD, FACC, et al., developed the risk calculator based on data from 10,345 TAVR patients at 350 institutions recorded in the STS/ACC TVT Registry between 2015 and 2017. Researchers only had access to data for self-expanding valves. Patients were divided into derivation and validation cohorts. A risk score was calculated using the derivation cohort based on multivariable predictors of 30-day unplanned readmissions and applied to the validation cohort.

Predictors of 30-day readmission used to develop the risk score included diabetes, atrial fibrillation, advanced heart failure symptoms, home oxygen use, gait speed or the inability to walk, serum creatinine levels, an index hospitalization length of stay greater than five days, major vascular complications and the degree of post-procedure aortic or mitral valve regurgitation. The mean age was 81.2 years.

Patients were stratified into low-, moderate- and high-risk subsets. There was a 2.5-fold difference in readmission rates between the low-risk (5.8 percent) and high-risk subsets (14.6 percent).

Study data showed that patients with early readmissions had higher 30-day rates for mortality (2.3 percent vs. 0.8 percent), stroke (4.1 percent vs. 2.7 percent), major vascular complications (2 percent vs. 1 percent) and new pacemaker implantation (25.7 percent vs. 18.6 percent).

"Unplanned readmissions in the U.S. are prevalent and costly, accounting for $41.3 billion in annual hospital payments, and are associated with adverse clinical outcomes," the authors concluded. "As alternative payment models continue to evolve in the U.S., a critical evaluation of different models will be essential to discovering whether there is a clinically meaningful effect on quality and high value care at a reasonable cost."

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Structural Heart Disease, Mitral Regurgitation

Keywords: STS/ACC TVT Registry, National Cardiovascular Data Registries, Patient Readmission, Patient Discharge, Creatinine, Atrial Fibrillation, Mitral Valve Insufficiency, Length of Stay, Transcatheter Aortic Valve Replacement, Hospitalization, Registries, Comorbidity, Cohort Studies, Stroke, Heart Failure, Pacemaker, Artificial, Diabetes Mellitus, Oxygen

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