Incidence, Predictors and Outcomes of Non-Home Discharge Following Transcatheter Aortic Valve Implantation: A Multicentre Australian Experience - The NHD TAVI Study.

Patients undergoing transcatheter aortic valve implantation (TAVI) commonly experience non-home discharge (NHD), a phenomenon associated with increased health-care expenditure and possibly poorer outcomes. Despite its clinical relevance in TAVI, the incidence and predictors of NHD and its impact on quality of life remain poorly characterised. Also unknown is the proportion of TAVI patients that require long-term residential care following initial NHD. Therefore, we aimed to address these questions using a large and multi-centre Australian cohort. 2229 patients undergoing TAVI from 2010-2023 included in the Alfred-Cabrini-Epworth TAVI Registry were analysed. Median age was 82 (IQR: 78-86) years and 41% were female. 257 (12%) patients were not discharged home following TAVI, with incidence falling over time (R2 =0.636, p<0.001). Multivariable logistic regression modelling for NHD prediction was developed with excellent calibration and discrimination (C-Statistic 0.835). Independent predictors of NHD were post-procedural stroke (adjusted odds ratio [aOR] 11.05), procedure at a private hospital (aOR 3.01), living alone (aOR 2.35), vascular access site complications (aOR 2.09), frailty (aOR 1.89), age>80 (aOR 1.82), hypoalbuminemia (aOR 1.76), NYHA III-IV (aOR 1.74) and hospital length of stay (aOR 1.13) (all p<0.05). NHD was not associated with mortality at 30-days and less than one percent of all patients required longer-term residential care. In conclusion, while common following TAVI, NHD does not predict short-term mortality, most patients successfully return home within 30-days and when used appropriately, NHD may serve as a brief and effective method of optimising functional status without compromising long-term independence.