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Master Thesis

Facteurs prédictifs des conditions de sortie d’hospitalisation post-TAVI : intérêt d’un questionnaire spécifique « Sortavi »

Abstract : Background: after an interventional procedure such as a Transcatheter Aortic Valve Implantation (TAVI), some patients are discharged to skilled nursing facilities. The procedure that leads a patient to be sent home or be sent to skilled nursing facilities is not clearly defined. The purpose of this study was to identify the factors that predict an “assisted discharge” after TAVI. Methods: this prospective, single-center study was conducted on a cohort of patients who underwent a TAVI from January to December 2018. Lifestyle information was collected prior to hospitalization through a telephone survey (“Sortavi”). The autonomy was assessed by Katz ADL (Activities daily living) score. In addition, clinical, biological, procedure-related, or hospital-related complications were collected. Results: 195 patients were included (average age 83 years old). 151 patients were sent home (simple discharge location) whereas 44 patients required an increase of assistance (rehabilitation centers, nursing homes, home care programs or home hospitalization). In a multivariate analysis, we identified different factors independently associated with the risk of an assisted discharge : active smoking (Odds Ratio[OR] = 9.99, Confidence Interval [CI] =1.83-54.40), history of thoracic radiotherapy (OR = 15.06, CI = 2.58- 87.96), severe mitral regurgitation pre-TAVI(OR = 8.14, CI = 1.20-55.10), functional decline defined by an ADL score less than 6/6 (OR = 2.56, CI = 1.03-6.34), living alone (OR = 3.42, CI = 1.51-7.72) and walking difficulty (OR = 3.05, CI = 1.25-7.40) before TAVI. Conclusion: during hospitalization for TAVI, smoking patients, history of thoracic radiotherapy, severe mitral regurgitation, functional decline, living alone and walking difficulty were significantly associated with an “assisted discharge”. These determinants should help the clinician decide the proper discharge location, in order to limit the length of stay.
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Master Thesis
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Christelle Silva. Facteurs prédictifs des conditions de sortie d’hospitalisation post-TAVI : intérêt d’un questionnaire spécifique « Sortavi ». Médecine humaine et pathologie. 2019. ⟨dumas-02499784⟩

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