TAVR patients admitted on weekend face greater risk of death, complications
Patients admitted for transcatheter aortic valve replacement (TAVR) on the weekend may face an increased risk of in-hospital mortality, according to new research published in BMC Cardiovascular Disorders.[1]
The study’s authors noted that some patients with severe aortic stenosis (AS) present over the weekend and require immediate care. Treating cardiovascular disease is often associated with a lower mortality rate, they added—does this “weekend effect” exist for TAVR as well?
“The weekend effect might occur in patients undergoing TAVR for AS because they share similar characteristics with cardiovascular diseases and require the involvement of the same cardiac team for intervention,” wrote co-first authors Guangzhi Cong and Bo Shi of General Hospital of Ningxia Medical University in China, and colleagues. “However, no studies have reported the effect of weekend admissions on TAVR hospitalization outcomes.”
To learn more, the group tracked National Inpatient Sample data from more than 82,000 TAVR hospitalizations that occurred in the United States from 2013 to 2021. While patients were admitted during the week 96.6% of the time, the remaining 3.4% were admitted during the weekend. As one may expect, patients admitted on the weekend were much more likely to be in need of emergency care and faced a higher burden of comorbidities.
Propensity score matching allowed the authors to focus on 2,688 weekend admissions for TAVR and 13,440 weekday admissions. Weekend patients were associated with a higher rate of in-hospital mortality (3.2% vs. 2.1%), much longer median lengths of stay (8 days vs. 4 days) and higher median hospitalization costs ($249,445 vs. $222,913). They were also linked to higher rates of paravalvular leak, cardiogenic shock, permanent pacemaker implantation (PPMI), endocarditis, cardiac arrest, acute kidney injury (AKI), acute ischemic stroke and blood transfusion.
After making certain adjustments and performing multivariable regression, weekend admissions were still linked to an increased risk of in-hospital mortality, cardiogenic shock, PPMI, AKI, acute ischemic stroke and blood transfusion.
The authors did note that the weekend effect may be decreasing over time as TAVR care advances—but it has not yet fully faded away.
“In-hospital mortality rates for weekend and weekday admissions showed a decreasing trend,” the authors wrote. “This trend likely reflects broader improvements in cardiovascular treatment and care, including technological advancements, refinements in clinical practices, and the efficient use of healthcare resources. Mortality rates remained higher for patients admitted on weekends than for those admitted on weekdays throughout the study period. This finding underscores the persistent presence of the ‘weekend effect’ and highlights the possibility of discrepancies in the quality of healthcare delivery between weekdays and weekends, not only within the United States but potentially worldwide.”
Cong, Shi and colleagues did emphasize that hospitals and health systems can take certain steps to improve outcomes for TAVR patients who require weekend care. For example, they wrote, adjusting schedules to maintain an “optimal physician-to-patient ratio” should be a priority.
“Additionally, advocating for policies aimed at allocating resources for recruiting additional physicians, nurses, and advanced care specialists is essential,” the team concluded. “These efforts will improve the continuum of care for patients and outcomes associated with weekend admissions.”
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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.