Factors Associated with Discharge to a Skilled Nursing Facility after Transcatheter Aortic Valve Replacement Surgery

Carolyn E. Horne, Tamara S. Goda, L. Wiley Nifong, Alan P. Kypson, Wesley T. O’Neal, Linda C. Kindell, Charulata Jindal and Jimmy T. Efird
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Carolyn E. Horne: College of Nursing, East Carolina University, Greenville, NC 27858, USA
Tamara S. Goda: Cardiovascular Sciences, East Carolina Heart Institute at Vidant Medical Center Greenville, Greenville, NC 27858, USA
L. Wiley Nifong: Robotic Surgery Center for Training and Education, East Carolina Heart Institute, Greenville, NC 27858, USA
Alan P. Kypson: Cardiac Surgical Specialists, REX Health Care, University of North Carolina, Raleigh, NC 27858, USA
Wesley T. O’Neal: Division of Cardiology, Emory University, Atlanta, GA 30322, USA
Linda C. Kindell: Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC 27858, USA
Charulata Jindal: Centre for Clinical Epidemiology and Biostatistics (CCEB), The University of Newcastle (UoN), Newcastle 2308, Australia
Jimmy T. Efird: Centre for Clinical Epidemiology and Biostatistics (CCEB), The University of Newcastle (UoN), Newcastle 2308, Australia

IJERPH, 2018, vol. 16, issue 1, 1-10

Abstract: An assumption regarding transcatheter aortic valve replacement (TAVR), a minimally invasive procedure for treating aortic stenosis, is that patients remain at, or near baseline and soon return to their presurgical home to resume activities of daily living. However, this does not consistently occur. The purpose of this study was to identify preoperative factors that optimally predict discharge to a skilled nursing facility (SNF) after TAVR. Delineation of these conditions is an important step in developing a risk stratification model to assist in making informed decisions. Data was extracted from the American College of Cardiology (ACC) transcatheter valve therapy (TVT) registry and the Society of Thoracic Surgeons (STS) database on 285 patients discharged from 2012–2017 at a tertiary referral heart institute located in the southeastern region of the United States. An analysis of assessment, clinical and demographic variables was used to estimate relative risk (RR) of discharge to a SNF. The majority of participants were female (55%) and white (84%), with a median age of 82 years (interquartile range = 9). Approximately 27% ( n = 77) were discharged to a SNF. Age > 75 years (RR = 2.3, p = 0.0026), female (RR = 1.6, p = 0.019), 5-meter walk test (5MWT) >7 s (RR = 2.0, p = 0.0002) and not using home oxygen (RR = 2.9, p = 0.0084) were identified as independent predictive factors for discharge to a SNF. We report a parsimonious risk-stratification model that estimates the probability of being discharged to a SNF following TAVR. Our findings will facilitate making informed treatment decisions regarding this older patient population.

Keywords: aortic stenosis; risk stratification; skilled nursing facility; transcatheter aortic valve replacement (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2018
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