Early discharge feasible following percutaneous mitral valve repair
medwireNews: Early discharge (ED) from hospital is feasible in selected patients following percutaneous edge-to-edge mitral valve repair (PMVR) and is not associated with an increase in adverse events, researchers report.
“Adoption of an ED strategy, when feasible, could reduce costs associated with PMVR and minimise unnecessary healthcare resource utilisation,” say Davide Capodanno, from University of Catania, Italy, and fellow researchers.
The team conducted a retrospective analysis of data from 269 patients undergoing PMVR who were included in the GRASP registry, and found that ED, defined as discharge within 72 hours of the procedure, “has been increasingly adopted,” with rates of 25.9% in 2008–2009 and 59.1% in 2014–2015.
Men were more than twice as likely as women to be discharged early (odds ratio [OR]=2.13), and the probability of ED increased with procedural year (OR=2.13 per biennium increase).
Conversely, atrial fibrillation, bleeding, log-N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, and postimplant mitral regurgitation grade were all associated with lower likelihood of ED, with ORs of 0.48, 0.07, 0.79, and 0.60, respectively.
No deaths occurred over 30 days of follow-up among patients who were discharged early. In propensity score-weighted analyses accounting for factors such as age, gender, smoking, and cardiovascular disease, the authors found no significant difference in overall survival, rehospitalization for heart failure, and major adverse events at 30 and 90 days between ED and late discharge (LD) patients.
Therefore, “a strategy of ED was not found to be more detrimental than a strategy of LD,” say the authors in Heart.
However, they concede that the ED and LD groups represented a different mix of patients, “with LD patients typically sicker than those candidates for ED.”
Indeed, atrial fibrillation was more common in the LD group than the ED group (48.1 vs 33.9%), and those in the LD group had higher NT-proBNP levels (5053.5 vs 3045.8 pg/mL) and a lower estimated glomerular filtration rate (46.9 vs 57.5 mL/min per 1.73m2.) at baseline.
“Although our propensity score model was well balanced, it is impossible to account for the unidentifiable confounders between these disparate groups of patients,” note Capodanno and colleagues.
However, they conclude that ED may be offered following PMVR “to patients at a lower baseline risk profile with effective and uncomplicated procedures.”
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