Prevention of readmission by intensified follow-up after transcatheter aortic valve implantation: Feasibility results of the PREMISS randomised controlled trial

Abstract

Background

Hospital readmissions after transcatheter aortic valve implantation (TAVI) are common. This study aimed to investigate the feasibility and impact of an intensified follow-up intervention on cardiac readmissions, mortality, and self-reported health status post-TAVI.

Methods

The study was designed as a randomised controlled trial to compare an early follow-up intervention with standard care. The intervention included tailored telephone and in-hospital consultations within 30 days post-TAVI. The feasibility outcomes were enrolment, attrition, and completion rates. Efficacy outcomes included all-cause mortality, cardiac-related hospital readmissions, and self-reported health status at 30 and 90 days after TAVI.

Results

Eighty patients were randomised to either the intensified or standard follow-up. The intervention was feasible, achieving a 73 % recruitment rate (target >50 %), 0 % attrition, 93 % questionnaire completion, and 100 % follow-up during the 30-day intervention and 90-day follow-up period. Detailed insights into processes, resources, management, and scientific approach of the intervention were provided. There was no mortality within 90 days in both groups. Cardiac readmissions within 90 days were 11 (28 %) in the standard care group vs 4 (10 %) in the intervention group (p = 0.04); this difference was mostly driven by short (<24-h) cardiac readmissions in the early post-TAVI period (13 % vs 0 %, respectively). Early improvements in self-reported health status occurred in both groups with no significant differences between groups.

Conclusion

An intensified follow-up intervention combining telephone and outpatient consultations after discharge from TAVI was shown to be feasible with high recruitment and completion rates. This study indicates that an intensified follow-up post-TAVI may prevent early cardiac readmissions.