In-hospital Outcomes and the Impact of Transfer Status in Nonelective vs Elective Transcatheter Aortic Valve Replacement.

Background: Nonelective transcatheter aortic valve replacement (TAVR) requires additional research to be fully understood. Methods: Using the National Inpatient Sample database (2016-2019), we conducted a retrospective cohort study comparing nonelective vs elective TAVR. The primary outcome of interest was the in-hospital mortality rate among patients undergoing nonelective TAVR, compared to that among patients undergoing elective TAVR. We matched patients in a greedy nearest-neighbor 1:1 model and multivariable logistic regression, which was adjusted for demographics, hospital factors, and comorbidities, and was used to compare mortality in our matched cohort. Results: Each cohort had 4389 patients in each cohort. When adjusted for age, race, sex, and comorbidities, nonelective TAVR patients had 1.99 times higher odds of suffering in-hospital mortality compared to elective admissions (adjusted odds ratio 1.99, 95% confidence interval: 1.42-2.81; P < 0.001). When separated by transfer status, nonelective patients admitted as regular hospital admissions or transferred from other acute-care centres also had higher odds of suffering in-hospital mortality compared to elective admissions. Conclusions: Our findings illustrate that nonelective TAVR patients are a vulnerable population that require additional medical support in the acute-care setting. As the demand for TAVR increases, further discussions regarding access to healthcare in underserved regions, the national physician shortage, and the future of the TAVR industry are imperative.

Contexte: Le remplacement valvulaire aortique par cathéter (RVAC) d'urgence nécessite plus de recherche pour être bien compris. Méthodologie: À partir de la base de données National Inpatient Sample (2016-2019), nous avons réalisé une étude rétrospective de cohortes comparant le RVAC non urgent et le RVAC d'urgence. Celle-ci avait pour principal critère d'évaluation la comparaison du taux de mortalité à l'hôpital chez les patients soumis à un RVAC d'urgence à celui noté chez ceux qui subissent un RVAC non urgent. Nous avons apparié les patients selon le modèle du plus proche voisin, avec un rapport 1:1, et utilisé une régression logistique multivariée, ajustée en fonction des caractéristiques démographiques, des facteurs hospitaliers et des affections concomitantes, pour comparer le taux de mortalité dans les cohortes appariées. Résultats: Chaque cohorte comportait 4 389 patients. Après correction pour tenir compte de l'âge, de l'origine ethnique, du sexe et des affections concomitantes, nous avons constaté que le risque des patients ayant subi un RVAC d'urgence de mourir à l'hôpital était 1,99 fois plus élevé que celui des patients chez qui un RVAC non urgent a été effectué (rapport des risques ajustés : 1,99; intervalle de confiance à 95 % : 1,42 à 2,81; p < 0,001). De plus, les patients chez qui l'intervention a été pratiquée d'urgence courraient également un risque plus élevé de décéder à l'hôpital que ceux soumis à un RVAC non urgent, qu'ils aient été admis directement à l'hôpital ou transférés d'autres centres de soins de courte durée. Conclusions: Nos conclusions montrent que les patients ayant subi un RVAC d'urgence forment une population vulnérable qui requiert un soutien médical supplémentaire dans un milieu de soins de courte durée. Comme la demande pour des RVAC augmente, d'autres discussions sur l'accès aux soins de santé dans les régions mal desservies, la pénurie nationale de médecins et l'avenir de l'industrie du RVAC s'imposent.

Impact of transfer from non-acute care centers on clinical outcomes in patients with congestive heart failure.

Study objective: To compare the clinical outcomes in patients with congestive heart failure who are transferred to an acute care hospital from non-acute care centers with patients who are admitted as regular hospital admissions. Design: This was a retrospective cohort study. Setting: We utilized the National Inpatient Sample database from 2016 to 2018. Participants: Our cohort consisted of hospitalized patients who were at least 18 years old with a primary diagnosis of congestive heart failure. Interventions: These patients were either transferred from non-acute centers or presented as regular hospital admissions. Main outcome measurements: We matched patients in a greedy nearest neighbor 1:1 model with caliper set at 0.2. Multivariable logistic regression, adjusted for age, sex, race and comorbidities, was used to compare mortality in our matched cohort. Results: This study included 35,010 non-acute care transfers and 951,189 regularly admitted patients. Compared to patients who were not transferred, non-acute care transfers were older, predominantly female, White and less racially diverse. After matching, there were 6689 patients in each cohort. When adjusted for age, race, sex and comorbidities, non-acute care transfers with congestive heart failure had 2.20 times higher odds of suffering in-hospital mortality compared to regular, non-transferred admissions (aOR 2.20, 95 % CI: 1.85-2.61; p < 0.001). Conclusion: Our findings illustrate that non-acute care transfers are a vulnerable population that require additional medical support in the acute care setting.