Next-day discharge after TMVR is on the rise
Next-day discharge (NDD) after transcatheter mitral valve repair (TMVR) is becoming more and more common, according to a new analysis published in the American Journal of Cardiology. Also, researchers found, complication rates appear to be decreasing for TMVR patients—though there are some noteworthy exceptions.
“With an aging population, the use of TMVR is expected to increase sharply in subsequent years,” wrote lead author Jelani K. Grant, MD, of the University of Miami Miller School of Medicine and Jackson Memorial Hospital. “Therefore, it is important to evaluate factors that may optimize patient care and improve future outcomes in those undergoing TMVR.”
Grant et al. tracked data from the National Inpatient Sample from 2013 to 2018. All patients underwent TMVR with the MitraClip device. Overall, the group found, the NDD approach was used for 35.7% of patients. Looking closer, the number of patients being discharged the next day increased from 18.3% in 2013 to 46% in 2018. A NDD approach was less common among TMVR patients who were female, Black or from a household with a lower median income. The NDD approach was also less common in cases frailty, major depressive disorder, obesity, anemia, thrombocytopenia, hypertension, diabetes, atherosclerotic cardiovascular disease, heart failure, pulmonary hypertension and chronic kidney disease.
The authors also noticed “an overall downward trend” of cardiovascular, bleeding and post-procedure complications. Some of the potential explanations for this shift include improved clinician experience, advancements in technique and the prioritization of shorter lengths of stay.
The group did note that, among patients who were not discharged the next day, complications started to suddenly increase from 2017 to 2018.
“Despite the overall decrease in complication rates in our study, there was a nadir in 2016 after which complications began increasing from 2017 to 2018,” the authors wrote. “We hypothesize that this increase in 2017-2018 may coincide with an increased off-label utilization of TMVR for secondary or functional MR in patients with more advanced stages of heart failure. Following the COAPT and MITRA-FR trials in 2018, the FDA approved TMVR with the MitraClip device for symptomatic moderate-to-severe/severe secondary or functional MR in March 2019.”
Grant and colleagues concluded that “larger multicenter, randomized trials” are still needed to confirm the safety and effectiveness of NDD after TMVR.
Read the full study here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.