Incidence, 30-day readmission rates and predictors of readmission after new onset atrial fibrillation who underwent transcatheter aortic valve replacement

Rajkumar Doshi; Sailaja Pisipati; Mohamed Taha; Mihir Dave; Jay Shah; Devina Adalja; Nageshwara Gullapalli

doi:10.1016/j.hrtlng.2019.10.011

Incidence, 30-day readmission rates and predictors of readmission after new onset atrial fibrillation who underwent transcatheter aortic valve replacement

Heart Lung. 2020 Mar-Apr;49(2):186-192. doi: 10.1016/j.hrtlng.2019.10.011. Epub 2019 Nov 2.

Authors

Rajkumar Doshi¹, Sailaja Pisipati², Mohamed Taha², Mihir Dave³, Jay Shah⁴, Devina Adalja⁵, Nageshwara Gullapalli²

Affiliations

¹ Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV 89502, United States. Electronic address: rdoshi@med.unr.edu.
² Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV 89502, United States.
³ Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV 89502, United States; Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
⁴ Department of Internal Medicine, Mercy St. Vincent Medical Center, Toledo, OH, USA.
⁵ Department of General Medicine, Gotri Medical Education and Research Center, Vadodara, Gujarat, India.

PMID: 31690493
DOI: 10.1016/j.hrtlng.2019.10.011

Abstract

Introduction: New onset Atrial Fibrillation (NOAF) is frequently seen post transcatheter aortic valve replacement (TAVR). NOAF in the setting of TAVR has also been recognized as predictor of worse outcomes, including higher readmission rates. Data assessing the effect and predictors of NOAF on 30-day readmission rates post TAVR is limited.

Objective: To assess the incidence, 30-day readmission rate and predictors of NOAF in patients who underwent TAVR.

Methods: Nationwide Readmissions Database was used to identify patients who developed NOAF post-TAVR between 2012 and 2015.

Results: A total of 24,076 patients were included in this study, of which 54% were males, and the mean age was 82.4 ± 7.2. NOAF was developed in 10,847 (45%) patients. Overall readmission rates with NOAF was 19.7% and trend in the readmissions reduced during the course of the study (21.9% to 18.7%, P_trend < 0.001). Thirty-day readmission rate in patients who developed NOAF post-TAVR was significantly higher compared to TAVR patients without NOAF (OR 1.39; 95% CI, 1.28-1.51; p < 0.001). Similarly, rate of ischemic stroke was significantly higher among patients who developed NOAF (OR 1.22; 95% CI, 1.07-1.4; p = 0.004). Predictors of readmissions in NOAF group were mostly non-cardiac, and included age, and comorbidities with chronic liver disease, renal failure and chronic lung disease been the most common comorbidities, in that order.

Conclusions: Incidence of NOAF is associated with increased risk of readmissions and ischemic stroke. Future research should focus on interventions to prevent avoidable readmissions and associated morbidity and mortality.

Keywords: New-onset atrial fibrillation; Readmission; Stroke; Transcatheter aortic valve replacement.

MeSH terms

Aged
Aged, 80 and over
Aortic Valve Stenosis / surgery
Atrial Fibrillation / epidemiology*
Comorbidity
Databases, Factual
Female
Humans
Incidence
Male
Patient Readmission / statistics & numerical data*
Risk Factors
Stroke / epidemiology
Transcatheter Aortic Valve Replacement*