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July 2017

Determinants, Associations, Consequences, and Prevention of Readmissions After Transcatheter Aortic Valve Replacement

Author Affiliations
  • 1University of Colorado Denver, Anchutz Medical Campus, Aurora
JAMA Cardiol. 2017;2(7):721-722. doi:10.1001/jamacardio.2017.1650

When I hear about one of our posttranscatheter aortic valve replacement (TAVR) patients being readmitted, I am disappointed from the perspective of wanting our patients to benefit from TAVR but I also want to know the cause and what could have been done to prevent it. Reducing readmission rates is a cost-reduction goal but more importantly, it is a patient-centric goal and a target for quality improvement. Is it related to a late complication such as the need for a pacemaker for heart block? Was it related to changes in medication we made? Was it related to a valve performance issue? Was it related to one of their other medical conditions? Or was it a system failure that we did not implement actions known to impact on this transition of care from inpatient to outpatient? We worry more about patients bouncing back into the hospital who have limited resources, no family or friends to help them, or who may have difficulties related to their ability to care for themselves. In summary, readmission is a “complex interplay between patient, health system, and the environment” as well articulated in heart failure by Hersh and colleagues.1

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