Reducing length of stay after transfemoral transcatheter aortic valve implantation: the FAST-TAVI II trial

Abstract Background and Aims The length of stay (LOS) after transcatheter aortic valve implantation (TAVI) remains extremely variable whereas early discharge has been shown to be feasible and safe. The study objective was to evaluate the efficacy and safety of an intervention aimed at reducing LOS a...

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Published in:European heart journal 2024-03, Vol.45 (11), p.952-962
Main Authors: Durand, Eric, Beziau-Gasnier, Delphine, Michel, Morgane, Iung, Bernard, Tchetche, Didier, Bonnet, Guillaume, Lhermusier, Thibault, Gilard, Martine, Souteyrand, Geraud, Bouleti, Claire, Ohlmann, Patrick, Lefevre, Thierry, Beygui, Farzin, Chassaing, Stephan, Chevreul, Karine, Eltchaninoff, Hélène
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Aortic Valve - surgery
Aortic Valve Stenosis - surgery
Humans
Length of Stay
Patient Discharge
Prospective Studies
Risk Factors
Transcatheter Aortic Valve Replacement
Treatment Outcome
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Summary:Abstract Background and Aims The length of stay (LOS) after transcatheter aortic valve implantation (TAVI) remains extremely variable whereas early discharge has been shown to be feasible and safe. The study objective was to evaluate the efficacy and safety of an intervention aimed at reducing LOS after transfemoral TAVI. Methods FAST-TAVI II is a prospective, multicentre, cluster, randomized, controlled study including patients with severe symptomatic aortic stenosis, who had transfemoral TAVI. The intervention consisted in a dedicated training programme to implement 10 quality of care measures to reduce LOS with an implementation phase of eight weeks. The primary endpoint was the proportion of patients discharged early within 3 days. Secondary endpoints included: LOS, 30-day mortality and 30-day incidence of readmission for cardiovascular events. Results During the study period, 969 patients were enrolled in the intervention group and 860 patients in the control group. Mean age was 81.9 ± 6.6 years and mean EuroSCORE II was 4.4 ± 4.5%. Early discharge was achieved in 563 (58.1%) patients in the intervention group vs. 364 (42.3%) patients in the control group (P < .0001). Median LOS was significantly reduced in the intervention group compared to the control group [3 (IQR: 3) vs. 4 days (IQR: 3), P < .0001]. Thirty-day mortality was low and similar in the two groups (0.5% vs. 0.9%, P = .30), as were 30-day readmissions (4.6% vs. 2.8%, P = .28). Conclusions The intervention was simple and fast to implement, and was effective and safe to reduce LOS and increase the proportion of patients discharged early after TAVI (NCT04503655). Structured Graphical Abstract Structured Graphical Abstract This prospective, multicentre, cluster, randomized controlled study included patients with severe symptomatic aortic stenosis who had transfemoral transcatheter aortic valve implantation in 20 French centres. Ten centres were allocated to the intervention group, which consisted in a dedicated training programme including 10 quality of care measures to reduce length of stay with an implementation phase of eight weeks. The other 10 centres received no training and carried on as usual (control group). The proportion of patients discharged early was significantly higher in the intervention group than in the control group in the overall population as well as in patients who received a balloon or a self-expandable prosthesis.
ISSN:0195-668X
1522-9645
DOI:10.1093/eurheartj/ehae081