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Association Between Wait Time for Transcatheter Aortic Valve Replacement and Early Postprocedural Outcomes

BACKGROUND: Rapid growth in transcatheter aortic valve replacement (TAVR) demand has translated to inadequate access, reflected by prolonged wait times. Increasing wait times are associated with important adverse outcomes while on the wait‐list; however, it is unknown if prolonged wait times influen...

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Autores principales: Elbaz‐Greener, Gabby, Yarranton, Brianne, Qiu, Feng, Wood, David A., Webb, John G., Fremes, Stephen E., Radhakrishnan, Sam, Wijeysundera, Harindra C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6405724/
https://www.ncbi.nlm.nih.gov/pubmed/30612506
http://dx.doi.org/10.1161/JAHA.118.010407
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author Elbaz‐Greener, Gabby
Yarranton, Brianne
Qiu, Feng
Wood, David A.
Webb, John G.
Fremes, Stephen E.
Radhakrishnan, Sam
Wijeysundera, Harindra C.
author_facet Elbaz‐Greener, Gabby
Yarranton, Brianne
Qiu, Feng
Wood, David A.
Webb, John G.
Fremes, Stephen E.
Radhakrishnan, Sam
Wijeysundera, Harindra C.
author_sort Elbaz‐Greener, Gabby
collection PubMed
description BACKGROUND: Rapid growth in transcatheter aortic valve replacement (TAVR) demand has translated to inadequate access, reflected by prolonged wait times. Increasing wait times are associated with important adverse outcomes while on the wait‐list; however, it is unknown if prolonged wait times influence postprocedural outcomes. Our objective was to determine the association between TAVR wait times and postprocedural outcomes. METHODS AND RESULTS: In this population‐based study in Ontario, Canada, we identified all TAVR procedures between April 1, 2010, and March 31, 2016. Wait time was defined as the number of days between initial referral and the procedure. Primary outcomes of interest were 30‐day all‐cause mortality and all‐cause readmission. Multivariable regression models incorporated wait time as a nonlinear variable, using cubic splines. The study cohort included 2170 TAVR procedures, of which 1741 cases were elective and 429 were urgent. There was a significant, nonlinear relationship between TAVR wait time and post‐TAVR 30‐day mortality, as well as 30‐day readmission. We observed an increased hazard associated with shorter wait times that diminished as wait times increased. This statistically significant nonlinear relationship was seen in the unadjusted model as well as after adjusting for clinical variables. However, after adjusting for case urgency status, there was no relationship between wait times and postprocedural outcomes. In sensitivity analyses restricted to either only elective or only urgent cases, there was no relationship between wait times and postprocedural outcomes. CONCLUSIONS: Wait time has a complex relationship with postprocedural outcomes that is mediated entirely by urgency status. This suggests that further research should elucidate factors that predict hospitalization requiring urgent TAVR while on the wait list.
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spelling pubmed-64057242019-03-21 Association Between Wait Time for Transcatheter Aortic Valve Replacement and Early Postprocedural Outcomes Elbaz‐Greener, Gabby Yarranton, Brianne Qiu, Feng Wood, David A. Webb, John G. Fremes, Stephen E. Radhakrishnan, Sam Wijeysundera, Harindra C. J Am Heart Assoc Original Research BACKGROUND: Rapid growth in transcatheter aortic valve replacement (TAVR) demand has translated to inadequate access, reflected by prolonged wait times. Increasing wait times are associated with important adverse outcomes while on the wait‐list; however, it is unknown if prolonged wait times influence postprocedural outcomes. Our objective was to determine the association between TAVR wait times and postprocedural outcomes. METHODS AND RESULTS: In this population‐based study in Ontario, Canada, we identified all TAVR procedures between April 1, 2010, and March 31, 2016. Wait time was defined as the number of days between initial referral and the procedure. Primary outcomes of interest were 30‐day all‐cause mortality and all‐cause readmission. Multivariable regression models incorporated wait time as a nonlinear variable, using cubic splines. The study cohort included 2170 TAVR procedures, of which 1741 cases were elective and 429 were urgent. There was a significant, nonlinear relationship between TAVR wait time and post‐TAVR 30‐day mortality, as well as 30‐day readmission. We observed an increased hazard associated with shorter wait times that diminished as wait times increased. This statistically significant nonlinear relationship was seen in the unadjusted model as well as after adjusting for clinical variables. However, after adjusting for case urgency status, there was no relationship between wait times and postprocedural outcomes. In sensitivity analyses restricted to either only elective or only urgent cases, there was no relationship between wait times and postprocedural outcomes. CONCLUSIONS: Wait time has a complex relationship with postprocedural outcomes that is mediated entirely by urgency status. This suggests that further research should elucidate factors that predict hospitalization requiring urgent TAVR while on the wait list. John Wiley and Sons Inc. 2019-01-05 /pmc/articles/PMC6405724/ /pubmed/30612506 http://dx.doi.org/10.1161/JAHA.118.010407 Text en © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research
Elbaz‐Greener, Gabby
Yarranton, Brianne
Qiu, Feng
Wood, David A.
Webb, John G.
Fremes, Stephen E.
Radhakrishnan, Sam
Wijeysundera, Harindra C.
Association Between Wait Time for Transcatheter Aortic Valve Replacement and Early Postprocedural Outcomes
title Association Between Wait Time for Transcatheter Aortic Valve Replacement and Early Postprocedural Outcomes
title_full Association Between Wait Time for Transcatheter Aortic Valve Replacement and Early Postprocedural Outcomes
title_fullStr Association Between Wait Time for Transcatheter Aortic Valve Replacement and Early Postprocedural Outcomes
title_full_unstemmed Association Between Wait Time for Transcatheter Aortic Valve Replacement and Early Postprocedural Outcomes
title_short Association Between Wait Time for Transcatheter Aortic Valve Replacement and Early Postprocedural Outcomes
title_sort association between wait time for transcatheter aortic valve replacement and early postprocedural outcomes
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6405724/
https://www.ncbi.nlm.nih.gov/pubmed/30612506
http://dx.doi.org/10.1161/JAHA.118.010407
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