Relation of Post-Discharge Care Fragmentation and Outcomes in Transcatheter Aortic Valve Implantation From the STS/ACC TVT Registry

Fragmented care following elective surgery has been associated with poor outcomes. The association between fragmented care and outcomes among patients undergoing transcatheter aortic valve implantation (TAVI) is unknown. We examined patients who underwent TAVI from 2011 to 2015 at 374 sites in the STS/ACC TVT Registry, linked to CMS claims data. Fragmented care was defined as at least one readmission to a site other than the implanting TAVI center within 90 days after discharge, whereas continuous care was defined as readmission to the same implanting center. We compared adjusted 1-year outcomes, including stroke, bleeding, heart failure, mortality, and all-cause readmission among patients who received fragmented vs. continuous care. Among 8,927 patients who received a TAVI between 2011 and 2015, 27.4% were readmitted within 90 days of discharge. Most patients received fragmented care (57.0%). Compared with the continuous care group, the fragmented care group were more likely to have severe chronic lung disease, cerebrovascular disease, and heart failure. States that had lower TAVI volume per CMS population had greater fragmentation. Patients living > 30 min from their TAVI center had an increased risk of fragmented care 1.07 (CI 1.06-1.09, p