Clinical outcome and cost analysis in patients admitted directly after TAVI to Cardiology Department as compared to Intensive Care Unit - The 68th Annual Conference of the Israel Heart Society in association with the Israel Society of Cardiothoracic Surgery

Ilanit Cohen ¹ Victor Guetta ^2,3 Amit Segev ^2,3 Paul Fefer ^2,3 Elad Maor ^2,3 Roy Beigel ^2,3 Shlomi Matetzky ^2,3 Israel Mazin ^2,3 Michael Berger ^2,3 Tomer Ziv-Baran ¹ Israel Moshe Barbash ^2,3

¹School of Public Health, Sackler Faculty of Medicine., Tel-Aviv University, Tel Aviv, Israel
²Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
³Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Background: Despite low complication rates, most patients are admitted to intensive care unit (ICU) after transcatheter aortic valve implantation (TAVI).
In 2017, a new protocol for direct admission to the Cardiology Department (CD) was initiated in Sheba Medical Center, allowing patients with an uncomplicated procedure, hemodynamically stable, and without new conduction abnormalities to be admitted directly to the CD after TAVI. The study aimed to compare the clinical outcome and cost analysis in patients admitted directly to the CD versus to the ICU.
Methods: Retrospective analysis comparing patients admitted directly to the CD according to the defined criteria (2017-2018) (CD group) versus patients undergoing TAVI prior to the protocol initiation (2015-2016) who met the defined criteria but were admitted to ICU (ICU group). Propensity score (PS) matching was utilized to match the two groups.
Results: Out of 260 patients, 130 were hospitalized in the ICU and 130 were hospitalized in the CD at the end of the procedure with no significant difference in combined adverse event end-point (in-hospital, 1-month, and 1-year mortality, in-hospital stroke, pacemaker implantation, and repeat admission within one month) (OR=1.26, p=0.501, CI 95% 0.7–2.5). After PS matching, no significant difference was found between the two cohorts apart from lower 1-year mortality among CD versus ICU patients (OR=0.3, p=0.035, CI 95% 0.09-0.9). Median hospitalization cost in CD cohort was 8,972 NIS (CI 95% 6,729-11,215), whereas the median cost in the ICU cohort was 14,480 NIS (9,994-17,235CI 95%) (p<0.001). In multivariable analysis, hospitalization in the ICU (p<0.001) and younger age (p=0.026) were associated with increased costs.
Conclusion: In selected patients, direct admission to the CD after TAVI should be considered as an appropriate alternative to ICU admission, with a similar complication rate and lower costs.

Ratio of complication by hospitalization department