BACKGROUND: Days at home (DAH) represents an important patient-oriented outcome that quantifies time spent at home after a medical event; however, this outcome has not been fully evaluated for low-surgical-risk patients undergoing transcatheter aortic valve replacement (TAVR). We sought to compare 1- and 2-year DAH (DAH 365 and DAH 730 ) among low-risk patients participating in a randomized trial of TAVR with a self-expanding bioprosthesis versus surgical aortic valve replacement (SAVR). METHODS: Using Medicare-linked data from the Evolut Low Risk trial, we identified 619 patients: 606 (322 TAVR/284 SAVR) and 593 (312 TAVR/281 SAVR) were analyzed at 1 and 2 years, respectively. DAH was calculated as days alive and spent outside a hospital, inpatient rehabilitation, skilled nursing facility, long-term acute care hospital, emergency department, or observation stay. Mean DAH was compared using the t test. RESULTS: The mean (SD) age and female sex were 74.7 (5.1) and 74.3 (4.9) years and 34.6% (115/332) and 30.3% (87/287) in TAVR and SAVR, respectively. Postprocedural discharge to rehabilitation occurred in ≤3.0% (≤10/332) in TAVR and 4.5% (13/287) in SAVR. The mean DAH 365 was comparable in TAVR versus SAVR (352.2±45.4 versus 347.8±39.0; difference in days, 4.5 [95% CI, 2.3–11.2]; P =0.20). DAH 730 was also comparable in TAVR versus SAVR (701.6±106.0 versus 699.6±94.5; difference in days, 2.0 [−14.1 to 18.2]; P =0.81). Secondary outcomes DAH 30 and DAH 90 were higher in TAVR (DAH 30 , 26.0±3.6 versus 20.7±6.4; difference in days, 5.3 [4.5–6.2]; P <0.001; DAH 90 , 85.1±8.3 versus 78.7±13.6; difference in days, 6.4 [4.6–8.2]; P <0.001). CONCLUSIONS: In the Evolut Low Risk trial linked to Medicare, low-risk patients undergoing TAVR spend a similar number of days at home at 1 and 2 years compared with SAVR. Days spent at home at 30 and 90 days were higher in TAVR. In contrast to higher-risk patients studied in prior work, there is no clear advantage of TAVR versus SAVR for DAH in the first 2 years after AVR in low-surgical-risk patients.

中文翻译：

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低风险患者经导管主动脉瓣置换术与手术主动脉瓣置换术后的居家天数

背景：在家天数 (DAH) 是一项以患者为中心的重要结果，可量化医疗事件后在家中度过的时间；然而，对于接受经导管主动脉瓣置换术（TAVR）的低手术风险患者来说，这一结果尚未得到充分评估。我们试图比较 1 年和 2 年 DAH（DAH365和DAH第730章）在参加一项随机试验的低风险患者中，该试验采用自膨式生物瓣膜进行 TAVR 与手术主动脉瓣置换术 (SAVR) 的比较。 方法：使用来自 Evolut Low Risk 试验的 Medicare 相关数据，我们识别了 619 名患者：分别在 1 年和 2 年分析了 606 名患者 (322 TAVR/284 SAVR) 和 593 名患者 (312 TAVR/281 SAVR)。DAH 计算为存活天数以及在医院、住院康复中心、熟练护理机构、长期急症护理医院、急诊室或观察停留期间度过的天数。使用以下方法比较平均 DAHt测试。 结果：TAVR 和 SAVR 的平均 (SD) 年龄和女性性别分别为 74.7 (5.1) 和 74.3 (4.9) 岁，分别为 34.6% (115/332) 和 30.3% (87/287)。TAVR 中术后出院康复的发生率≤3.0% (≤10/332)，SAVR 中术后出院康复的发生率为 4.5% (13/287)。平均DAH365TAVR 与 SAVR 具有可比性（352.2±45.4 与 347.8±39.0；天数差异，4.5 [95% CI，2.3–11.2]；磷=0.20）。DAH第730章TAVR 与 SAVR 也具有可比性（701.6±106.0 与 699.6±94.5；天数差异 2.0 [−14.1 至 18.2]；磷=0.81）。次要结果 DAH30和DAH90TAVR（DAH30，26.0±3.6 与 20.7±6.4；天数差异，5.3 [4.5–6.2]；磷<0.001；DAH90，85.1±8.3 对比 78.7±13.6；天数差异，6.4 [4.6–8.2]；磷<0.001）。 结论：在与 Medicare 相关的 Evolut Low Risk 试验中，接受 TAVR 的低风险患者在 1 年和 2 年在家中度过的天数与 SAVR 相似。TAVR 治疗 30 天和 90 天时在家中度过的天数较高。与之前研究的高风险患者相比，低手术风险患者在 AVR 后的头 2 年内，TAVR 与 SAVR 治疗 DAH 没有明显优势。