Same-day discharge after TAVR is feasible and safe, new Cleveland Clinic study confirms
Same-day discharge (SDD) after transcatheter aortic valve replacement (TAVR) is a feasible treatment option that does not have a negative impact on outcomes, according to a new analysis published in JACC: Cardiovascular Interventions.[1]
“At many centers, next-day discharge (NDD) post-TAVR is quite common and is seen among more than 25% of TAVR recipients nationwide,” wrote first author Amar Krishnaswamy, MD, a cardiologist with the Cleveland Clinic’s Heart, Vascular and Thoracic Institute, and colleagues. “Since the COVID-19 pandemic began worldwide in early 2020, healthcare systems have faced the challenges of optimizing utilization in a period of limited space and personnel resources and minimizing coronavirus exposure during hospitalization in compliance with clinical triage recommendations. Under this need for hospital management change, our institution implemented a protocol for the SDD of carefully selected TAVR recipients beginning in March 2020.”
Krishnaswamy et al. examined the potential impact of this policy shift by reviewing data from more than 1,000 adult TAVR patients treated at their facility. All underwent transfemoral TAVR from January 2019 to November 2020. The median patient age was 79 years old, and 59.9% were men.
The analysis included 597 TAVR patients treated in 2019, including 481 patients who went home the next day. An additional 516 TAVR patients were treated in 2020, with 443 going home either the same day (114) or the next day (329).
Overall, there were no significant differences in in-hospital events or 30-day readmissions between SDD and NDD patients. There were also no patient deaths reported after SDD. Procedure end time (before or after noon) was the single strongest predictor of whether a patient would be chosen for SDD or NDD; SDD was also more likely among men and patients with a high baseline hemoglobin level.
In addition, SDD patients in 2020 and NDD patients in 2019 had similar rates of permanent pacemaker (PPM) and implantable cardioverter-defibrillator (ICD) implantation within 30 days of discharge.
“Delayed conduction disturbance post-discharge due to limited monitoring is a concern when discharging patients early after TAVR,” the authors wrote. “However, our PPM or ICD rate from discharge to 30 days was low (0.7% in 2019 and 1.0% in 2020), which was comparable to that in recent post-TAVR NDD studies. These observations support that advanced conduction disorders are uncommon after discharge in patients carefully selected for SDD or NDD.”
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.