Impact of Discharge Location After Transcatheter Aortic Valve Replacement on 1-Year Outcomes in Women: Results From the WIN-TAVI Registry.
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Mehilli Julinda, Chandrasekhar Jaya, Sartori Samantha, Chieffo Alaide, Petronio Anna S, Lefèvre Thierry, Presbitero Patrizia, Capranzano Piera, Tchetche Didier, Iadanza Alessandro, Sardella Gennaro, Van Mieghem Nicolas M, Meliga Emanuela, Dumonteil Nicolas, Fraccaro Chiara, Trabattoni Daniela, Jochheim David, Zadrozny Magda, Mikhail Ghada W, Sharma Samin, Ferrer Maria C, Naber Christoph, Kievit Peter, Moalem Kamilia, Baber Usman, Snyder Clayton, Sharma Madhav, Morice Marie C, Mehran Roxana, Women’s INternational Transcatheter Aortic Valve Implantation (WIN-TAVI) Investigators
Аннотация
METHODS: The Women's INternational Transcatheter Aortic Valve Implantation (WIN-TAVI) registry is the first all-female TAVR registry to study the safety and performance of contemporary TAVR in women (n = 1019). Information on discharge location was available in 817 patients (80.2%). We compared women discharged home vs those discharged to another location (nursing home, rehabilitation, or other hospital). One-year outcomes were adjusted using multivariable Cox regression methods with discharge home as the reference group.
RESULTS: Of the study subjects, 75.2% (n = 614) were discharged home and 24.8% (n = 203) to another location. Women discharged to other locations were older with a greater prevalence of severe lung disease requiring home oxygen and renal failure on dialysis but were less frequently considered frail or at high surgical risk compared with women discharged home. After multivariable adjustment, non-home discharge was associated with greater hazard for 1-year Valve Academic Research Consortium 2 efficacy (21.3% vs 10.8%, hazards ratio [HR] 1.9, 95% confidence interval [CI] 1.2-2.9) and safety endpoints (31.5% vs 15.2%, HR 2.1, 95% CI 1.5-3.0), cardiovascular death (12.7% vs 5.5%, HR 2.0, 95% CI 1.1-3.6), and stroke (6.5% vs 0.8%, HR 8.5, 95% CI 2.9-25.6).
CONCLUSIONS: In women undergoing contemporary TAVR, discharge disposition significantly affects 1-year risk of outcomes even after adjustment for recorded baseline differences. This might suggest the necessity of considering additional factors beyond comorbidities in the TAVR decision-making process.