Safety and Cost Implications of Same-Day Discharge Following Elective Percutaneous Closure of Patent Foramen Ovale and Atrial Septal Defects in Australia

Background: Percutaneous closure of patent foramen ovale (PFO) and atrial septal defects (ASD) is being more commonly performed due to changes in international guidelines supporting its use. This study was performed to determine the clinical outcomes, safety and cost implications of same-day discharge (SDD) following such procedures and place this in an Australian context. Methods: This was a retrospective, observational study of patients undergoing elective percutaneous PFO or ASD closure at St. George Hospital, Australia between January 2011 and January 2020. Primary outcomes included 30-day major adverse cardiovascular endpoints (MACE) and readmission to hospital within 30 days. Results: Twenty-four patients were included in the primary analysis. Ten (41.7%) patients underwent elective ASD closure while 14 (58.3%) underwent PFO closure. Among the 24 patients who underwent elective percutaneous closure of structural heart disease, 23 patients (95.8%) were managed with SDD. There were no MACE outcomes at 30 days. No patients were re-admitted to hospital at 30 days following these procedures. When compared to overnight admission to hospital post-elective percutaneous structural heart condition closure, SDD yielded a cost saving of AUD 5999 per case. Conclusion: SDD following elective percutaneous closure of ASD and PFO was demonstrated to be a safe and effective strategy for managing patients. With more widespread use, it can lead to significant cost savings for hospitals without compromising patient care.

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Percutaneous closure of patent foramen ovale, atrial septal defects and the left atrial appendage

Essential Interventional Cardiology ◽

10.1016/b978-0-7020-2981-3.50037-4 ◽

2008 ◽

pp. 449-468

Author(s):

STEPHAN WINDECKER ◽

BERNHARD MEIER

Keyword(s):

Left Atrial ◽

Patent Foramen Ovale ◽

Left Atrial Appendage ◽

Percutaneous Closure ◽

Atrial Appendage ◽

Foramen Ovale ◽

Septal Defects ◽

Atrial Septal Defects

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Incidence of aortic valve regurgitation and outcome after percutaneous closure of atrial septal defects and patent foramen ovale

Yearbook of Cardiology ◽

10.1016/s0145-4145(08)79312-2 ◽

2009 ◽

Vol 2009 ◽

pp. 174-175

Author(s):

T. Graham

Keyword(s):

Aortic Valve ◽

Patent Foramen Ovale ◽

Percutaneous Closure ◽

Foramen Ovale ◽

Valve Regurgitation ◽

Aortic Valve Regurgitation ◽

Septal Defects ◽

Atrial Septal Defects

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Mild aortic valve insufficiency: A mid-term complication of percutaneous closure of atrial septal defects and patent foramen ovale

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(03)82703-1 ◽

2003 ◽

Vol 41 (6) ◽

pp. 496 ◽

Cited By ~ 1

Author(s):

Steffen Schoen ◽

Mathias Schulze ◽

Stefan Lange ◽

Steffen Bohl ◽

Martin U. Braun ◽

...

Keyword(s):

Aortic Valve ◽

Patent Foramen Ovale ◽

Percutaneous Closure ◽

Aortic Valve Insufficiency ◽

Foramen Ovale ◽

Septal Defects ◽

Atrial Septal Defects ◽

Valve Insufficiency

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Incidence of aortic valve regurgitation and outcome after percutaneous closure of atrial septal defects and patent foramen ovale

Heart ◽

10.1136/hrt.2007.132662 ◽

2008 ◽

Vol 94 (7) ◽

pp. 844-847 ◽

Cited By ~ 43

Author(s):

S P Schoen ◽

A Boscheri ◽

S A Lange ◽

M U Braun ◽

J Fuhrmann ◽

...

Keyword(s):

Aortic Valve ◽

Patent Foramen Ovale ◽

Percutaneous Closure ◽

Foramen Ovale ◽

Valve Regurgitation ◽

Aortic Valve Regurgitation ◽

Septal Defects ◽

Atrial Septal Defects

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Developing A Random Forest Algorithm to Identify Patent Foramen Ovale and Atrial Septal Defects in Ontario Administrative Databases

10.21203/rs.3.rs-558122/v1 ◽

2021 ◽

Author(s):

Laura Oliva ◽

Eric Horlick ◽

Bo Wang ◽

Ella Huszti ◽

Ruth Hall ◽

...

Keyword(s):

Random Forest ◽

Administrative Data ◽

Patent Foramen Ovale ◽

Transcatheter Closure ◽

Variable Importance ◽

Foramen Ovale ◽

Final Model ◽

Septal Defects ◽

Atrial Septal Defects ◽

Asd Closure

Abstract Purpose: Routinely collected administrative data is widely used for population-based research. However, although clinically very different, atrial septal defects (ASD) and patent foramen ovale (PFO) share a single diagnostic code (ICD-9: 745.5, ICD-10: Q21.1). Using machine-learning based approaches we developed and validated an algorithm to differentiate between PFO and ASD patient populations within healthcare administrative data. Methods: Using data housed at ICES, we identified patients who underwent transcatheter closure in Ontario between October 2002 and December 2017 using a code (1HN80GPFL, N = 4680). A novel random forest model was developed using demographic and clinical information. Those patients who had undergone transcatheter closure and had records in the CorHealth Ontario cardiac procedure registry (N = 1482) were used as the reference standard. Several algorithms were tested and evaluated for accuracy, sensitivity, and specificity. Variable importance was examined via mean decrease in Gini index. Results: We tested 7 models in total. The final model included 24 variables, including demographic, comorbidity, and procedural information. After hyperparameter tuning, the final model achieved 0.76 accuracy, 0.76 sensitivity, and 0.75 specificity. Patient age group had the greatest influence on node impurity, and thus ranked highest in variable importance. Conclusions: Our random forest classification method achieved reasonable accuracy in identifying PFO and ASD closure in administrative data. The algorithm can now be applied to evaluate long term PFO and ASD closure outcomes in Ontario. Future external validation studies are recommended to further test the algorithm.

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