Reducing length of stay after transfemoral transcatheter aortic valve implantation : the FAST-TAVI II trial
© 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.permissionsoup.com..
BACKGROUND AND AIMS: 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: 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: 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: 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).
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:45 |
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| Enthalten in: |
European heart journal - 45(2024), 11 vom: 14. März, Seite 952-962 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Durand, Eric [VerfasserIn] |
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| Links: |
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| Themen: |
Aortic stenosis |
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| Anmerkungen: |
Date Completed 18.03.2024 Date Revised 18.03.2024 published: Print ClinicalTrials.gov: NCT04503655 Citation Status MEDLINE |
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| doi: |
10.1093/eurheartj/ehae081 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM369274954 |
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| 500 | |a ClinicalTrials.gov: NCT04503655 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 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.permissionsoup.com. | ||
| 520 | |a BACKGROUND AND AIMS: 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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) | ||
| 520 | |a 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) | ||
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Aortic stenosis | |
| 650 | 4 | |a Length of stay | |
| 650 | 4 | |a TAVI | |
| 700 | 1 | |a Beziau-Gasnier, Delphine |e verfasserin |4 aut | |
| 700 | 1 | |a Michel, Morgane |e verfasserin |4 aut | |
| 700 | 1 | |a Iung, Bernard |e verfasserin |4 aut | |
| 700 | 1 | |a Tchetche, Didier |e verfasserin |4 aut | |
| 700 | 1 | |a Bonnet, Guillaume |e verfasserin |4 aut | |
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| 700 | 1 | |a Chassaing, Stephan |e verfasserin |4 aut | |
| 700 | 1 | |a Chevreul, Karine |e verfasserin |4 aut | |
| 700 | 1 | |a Eltchaninoff, Hélène |e verfasserin |4 aut | |
| 700 | 0 | |a FAST-TAVI II |e verfasserin |4 aut | |
| 700 | 0 | |a STOP-AS investigators |e verfasserin |4 aut | |
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| 700 | 1 | |a Bar, Olivier |e investigator |4 oth | |
| 700 | 1 | |a Barbey, Christophe |e investigator |4 oth | |
| 700 | 1 | |a Bertrand, Bernard |e investigator |4 oth | |
| 700 | 1 | |a Beygui, Farzin |e investigator |4 oth | |
| 700 | 1 | |a Bignon, Mathieu |e investigator |4 oth | |
| 700 | 1 | |a Bouchat, Marine |e investigator |4 oth | |
| 700 | 1 | |a Bouisset, Frédéric |e investigator |4 oth | |
| 700 | 1 | |a Bouleti, Claire |e investigator |4 oth | |
| 700 | 1 | |a Campelo-Parada, Fransisco |e investigator |4 oth | |
| 700 | 1 | |a Chassaing, Stephan |e investigator |4 oth | |
| 700 | 1 | |a Combaret, Nicolas |e investigator |4 oth | |
| 700 | 1 | |a Darodes, Nicole |e investigator |4 oth | |
| 700 | 1 | |a Delepine, Stéphane |e investigator |4 oth | |
| 700 | 1 | |a Didier, Romain |e investigator |4 oth | |
| 700 | 1 | |a Dongay, Bruno |e investigator |4 oth | |
| 700 | 1 | |a Dumonteil, Nicolas |e investigator |4 oth | |
| 700 | 1 | |a Fouassier, David |e investigator |4 oth | |
| 700 | 1 | |a Gallet de Saint Aurin, Romain |e investigator |4 oth | |
| 700 | 1 | |a Gilard, Martine |e investigator |4 oth | |
| 700 | 1 | |a Gouffran, Guillaume |e investigator |4 oth | |
| 700 | 1 | |a Himbert, Dominique |e investigator |4 oth | |
| 700 | 1 | |a Le Bivic, Louis |e investigator |4 oth | |
| 700 | 1 | |a Lefèvre, Thierry |e investigator |4 oth | |
| 700 | 1 | |a Lemaitre, Adrien |e investigator |4 oth | |
| 700 | 1 | |a Leroux, Lionel |e investigator |4 oth | |
| 700 | 1 | |a Levy, Gilles |e investigator |4 oth | |
| 700 | 1 | |a Lhermusier, Thibaut |e investigator |4 oth | |
| 700 | 1 | |a Lorgis, Luc |e investigator |4 oth | |
| 700 | 1 | |a Morelle, Jean-François |e investigator |4 oth | |
| 700 | 1 | |a Ohlmann, Patrick |e investigator |4 oth | |
| 700 | 1 | |a Piot, Christophe |e investigator |4 oth | |
| 700 | 1 | |a Pommier, Thibaut |e investigator |4 oth | |
| 700 | 1 | |a Rebouh, Idir |e investigator |4 oth | |
| 700 | 1 | |a Roule, Vincent |e investigator |4 oth | |
| 700 | 1 | |a Rusinaru, Dan |e investigator |4 oth | |
| 700 | 1 | |a Souteyrand, Géraud |e investigator |4 oth | |
| 700 | 1 | |a Spaulding, Christian |e investigator |4 oth | |
| 700 | 1 | |a Tchetche, Didier |e investigator |4 oth | |
| 700 | 1 | |a Teiger, Emmanuel |e investigator |4 oth | |
| 700 | 1 | |a Tribouilloy, Christophe |e investigator |4 oth | |
| 700 | 1 | |a Eltchaninoff, Hélène |e investigator |4 oth | |
| 700 | 1 | |a Bellien, Jérémy |e investigator |4 oth | |
| 700 | 1 | |a Bertrand, Benjamin |e investigator |4 oth | |
| 700 | 1 | |a Beygui, Farzin |e investigator |4 oth | |
| 700 | 1 | |a Béziau-Gasnier, Delphine |e investigator |4 oth | |
| 700 | 1 | |a Brakenhielm, Ebba |e investigator |4 oth | |
| 700 | 1 | |a Caligiuri, Giuseppina |e investigator |4 oth | |
| 700 | 1 | |a Chevreul, Karine |e investigator |4 oth | |
| 700 | 1 | |a Debroucker, Frédérique |e investigator |4 oth | |
| 700 | 1 | |a Durand, Eric |e investigator |4 oth | |
| 700 | 1 | |a Fraschini, Christophe |e investigator |4 oth | |
| 700 | 1 | |a Gilard, Martine |e investigator |4 oth | |
| 700 | 1 | |a Iung, Bernard |e investigator |4 oth | |
| 700 | 1 | |a Kamel, Said |e investigator |4 oth | |
| 700 | 1 | |a Laschet, Jamila |e investigator |4 oth | |
| 700 | 1 | |a Manrique, Alain |e investigator |4 oth | |
| 700 | 1 | |a Messas, Emmanuel |e investigator |4 oth | |
| 700 | 1 | |a Messika-Zeitoun, David |e investigator |4 oth | |
| 700 | 1 | |a Pinet, Florence |e investigator |4 oth | |
| 700 | 1 | |a Richard, Vincent |e investigator |4 oth | |
| 700 | 1 | |a Saloux, Eric |e investigator |4 oth | |
| 700 | 1 | |a Thoenes, Martin |e investigator |4 oth | |
| 700 | 1 | |a Tribouilloy, Christophe |e investigator |4 oth | |
| 700 | 1 | |a Vézier, Claire |e investigator |4 oth | |
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