Reducing length of stay after transfemoral transcatheter aortic valve implantation: the FAST-TAVI II trial.
Aortic stenosis
Length of stay
TAVI
Journal
European heart journal
ISSN: 1522-9645
Titre abrégé: Eur Heart J
Pays: England
ID NLM: 8006263
Informations de publication
Date de publication:
14 Mar 2024
14 Mar 2024
Historique:
received:
30
06
2023
revised:
22
11
2023
accepted:
29
01
2024
medline:
18
3
2024
pubmed:
4
3
2024
entrez:
4
3
2024
Statut:
ppublish
Résumé
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. 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. 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). 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).
Sections du résumé
BACKGROUND AND AIMS
OBJECTIVE
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
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
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
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).
Identifiants
pubmed: 38437633
pii: 7618769
doi: 10.1093/eurheartj/ehae081
doi:
Banques de données
ClinicalTrials.gov
['NCT04503655']
Types de publication
Randomized Controlled Trial
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
952-962Subventions
Organisme : French Government
Organisme : National Research Agency
Organisme : ANR
ID : ANR-16-RHUS-0003_STOP-AS
Investigateurs
Benjamin Alos
(B)
Marc-Antoine Arnould
(MA)
Olivier Bar
(O)
Christophe Barbey
(C)
Bernard Bertrand
(B)
Farzin Beygui
(F)
Mathieu Bignon
(M)
Marine Bouchat
(M)
Frédéric Bouisset
(F)
Claire Bouleti
(C)
Fransisco Campelo-Parada
(F)
Stephan Chassaing
(S)
Nicolas Combaret
(N)
Nicole Darodes
(N)
Stéphane Delepine
(S)
Romain Didier
(R)
Bruno Dongay
(B)
Nicolas Dumonteil
(N)
David Fouassier
(D)
Romain Gallet de Saint Aurin
(R)
Martine Gilard
(M)
Guillaume Gouffran
(G)
Dominique Himbert
(D)
Louis Le Bivic
(L)
Thierry Lefèvre
(T)
Adrien Lemaitre
(A)
Lionel Leroux
(L)
Gilles Levy
(G)
Thibaut Lhermusier
(T)
Luc Lorgis
(L)
Jean-François Morelle
(JF)
Patrick Ohlmann
(P)
Christophe Piot
(C)
Thibaut Pommier
(T)
Idir Rebouh
(I)
Vincent Roule
(V)
Dan Rusinaru
(D)
Géraud Souteyrand
(G)
Christian Spaulding
(C)
Didier Tchetche
(D)
Emmanuel Teiger
(E)
Christophe Tribouilloy
(C)
Hélène Eltchaninoff
(H)
Jérémy Bellien
(J)
Benjamin Bertrand
(B)
Farzin Beygui
(F)
Delphine Béziau-Gasnier
(D)
Ebba Brakenhielm
(E)
Giuseppina Caligiuri
(G)
Karine Chevreul
(K)
Frédérique Debroucker
(F)
Eric Durand
(E)
Christophe Fraschini
(C)
Martine Gilard
(M)
Bernard Iung
(B)
Said Kamel
(S)
Jamila Laschet
(J)
Alain Manrique
(A)
Emmanuel Messas
(E)
David Messika-Zeitoun
(D)
Florence Pinet
(F)
Vincent Richard
(V)
Eric Saloux
(E)
Martin Thoenes
(M)
Christophe Tribouilloy
(C)
Claire Vézier
(C)
Informations de copyright
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.