Home health care utilization trend, predictors, and association with early rehospitalization following endovascular transcatheter aortic valve replacement.

Authors

Salik Nazir, Division of Cardiovascular Medicine, Department of Medicine, University of Toledo Medical Center, Toledo, OH
Keerat R. Ahuja, Department of Cardiology, Reading Hospital-Tower Health System, West Reading, PAFollow
Robert W Ariss, Division of Cardiovascular Medicine, Department of Medicine, University of Toledo Medical Center, Toledo, OH
Khalid Changal, Division of Cardiovascular Medicine, Department of Medicine, University of Toledo Medical Center, Toledo, OH
Sadik A Khuder, Department of Medicine and Public Health, University of Toledo, Toledo, OH
George V Moukarbel, Division of Cardiovascular Medicine, Department of Medicine, University of Toledo Medical Center, Toledo, OH

Document Type

Article

Publication Date

5-24-2021

Abstract

BACKGROUND/PURPOSE: Home healthcare (HHC) utilization is associated with higher rates of rehospitalization in patients with heart failure and transcatheter mitral valve repair. This study sought to assess the utilization, predictors, and the association of HHC with 30-day readmission in patients undergoing transcatheter aortic valve replacement (TAVR).

METHODS/MATERIALS: We queried the Nationwide Readmission Database from January 2012 to December 2017 for TAVR discharges with and without HHC referral. Using multivariate analysis, we identified predictors of HHC utilization, and its association with outcomes.

RESULTS: Of 60,950 TAVR discharges, 21,724 (35.7%) had HHC referral. On multivariable analysis, female sex (OR, 1.34; 95% CI, 1.29-1.40), non-elective admission (OR, 1.49; 95% CI, 1.42-1.56), diabetes mellitus (OR, 1.09; 95% CI, 1.05-1.13), prior stroke (OR, 1.06; 95% CI, 1.01-1.12), anemia (OR, 1.16; 95% CI, 1.11-1.21), and in-hospital complications including cardiogenic shock (OR, 1.37; 95% CI, 1.16-1.50), cardiac arrest (OR, 1.22; 95% CI, 1.00-1.50), stroke (OR, 2.62; 95% CI, 2.20-3.18), and new Permanent pacemaker (OR, 1.49; 95% CI, 1.41-1.58) were identified as independent predictors of HHC referral. HHC utilization was associated with longer median length of stay (4 days vs. 2 days, P < 0.001), higher rate of 30-day all-cause (15.5% vs. 10.6%, P < 0.001) and heart failure (2.1%vs. 1.1%, P < 0.001) readmission rates compared to those without HHC.

CONCLUSIONS: Our study identified a vulnerable group of TAVR patients that are at higher risk of 30-day readmission. Evidence-based interventions proven effective in reducing the burden of readmissions should be pursed in these patients to improve outcomes and quality of life.

Publication Title

Cardiovasc Revasc Med

Comments

Online ahead of print

Recommended Citation

Nazir, S., Ahuja, K. R., Ariss, R., Changal, K., Khuder, S., & Moukarbel, G. (2021). Home health care utilization trend, predictors, and association with early rehospitalization following endovascular transcatheter aortic valve replacement.. Cardiovasc Revasc Med https://doi.org/DOI: 10.1016/j.carrev.2021.05.019