Emergency Department Visits Following Transcatheter Cardiac Interventions: A Systematic Review and Meta-Analysis

While hospital readmission is the most common health system performance metric after transcatheter cardiac interventions, emergency department (ED) visits are rarely evaluated. We aimed to synthesize the incidence, causes, predictors, costs, and outcomes of ED visits following transcatheter procedures in patients undergoing percutaneous coronary interventions (PCI), atrial septal defect (ASD) closures, patent foramen ovale (PFO) closures, and transcatheter aortic valve interventions (TAVI). Embase and Medline databases were searched from January 01, 2004, to July 25, 2024. We descriptively summarized ED visit outcomes for all studies and, when relevant, performed a meta-analysis to obtain a pooled mean cumulative incidence for 30-day ED visits following intervention. Nineteen studies met the eligibility criteria, nine of which were subsequently meta-analyzed. The incidence of 30-day ED visits in individual studies ranged from 2.8% to 22% for PCI patients, 4% to 15.3% for TAVI patients, and 16.9% to 19.5% for ASD/PFO patients. The pooled mean cumulative incidence of 30-day ED visits was 9% (95% CI: 3%-18%) for PCI patients and 12% (95% CI: 9%-15%) for TAVI patients. A high degree of between-study heterogeneity was found in the meta-analysis of these outcomes. Based on limited reporting, risk factors associated with ED visits varied by procedure and included factors such as urgency of procedure, length of stay, sex, age, and dementia. The incidence and predictors of ED visits post-transcatheter cardiac interventions were noteworthy yet highly variable and inconsistently reported. Further research into the risk factors that contribute to ED visits is needed to capture the burden of this outcome.