Nearly 1 in 10 patients who receive percutaneous coronary intervention (PCI) end up back in the hospital with an unplanned readmission within 30 days, according to a study published online April 2 in JACC: Cardiovascular Interventions. These readmissions are usually for noncardiac causes and heavily linked to a patient’s comorbidities and place of discharge, the researchers found.
“The majority of readmissions within 30 days are noncardiac (56 percent), with female sex, chronic kidney disease, liver failure, atrial fibrillation, increasing comorbidity burden and discharge location among the strongest predictors of unplanned 30-day readmission,” wrote lead author Chun Shing Kwok, MBBS, MSc, BSc, and colleagues, who studied 833,344 U.S. patients discharged after PCI in 2013 and 2014.
“Patients who experienced an unplanned readmission for noncardiac reasons tended to be younger, with more comorbidities, including alcohol misuse, cancer, and dementia, whereas patients who are readmitted for cardiac reasons are more likely to have in-hospital complications at their index PCI event.”
Overall, 9.3 percent of patients had an unplanned readmission within 30 days. Considering in-hospital mortality after PCI is less than 1 percent, readmissions after the procedure are “increasingly being recognized as an important post-discharge outcome,” the authors noted. Readmissions can be burdensome to patients and their families, as well as the local healthcare economy, and some payment models are beginning to penalize hospitals that have higher-than-expected readmission rates.
Kwok et al. found that patients who were eventually readmitted had longer (4.7 versus 3.9 days) stays during their initial PCI hospitalization. They also cost significantly more—an index PCI visit plus a first readmission was $37,524 compared to $23,211 for a single hospitalization.
Those who were discharged against medical advice had twice the risk of ending up back in the hospital, while those sent to a short-term hospital for inpatient care or to a care facility had increased readmissions risks of 62 and 57 percent, respectively.
In addition, the average number of comorbidities in the readmitted group was 5.7 compared to 4.9 for those who weren’t readmitted.
“Our results suggest that 30-day readmissions in the United States is common and comorbid illnesses and places of discharge are important factors that influence readmissions,” Kwok and colleagues wrote. “Clinicians should focus on the optimization of the management of any comorbid condition during a patient's index admission for PCI and consider developing outreach programs to patients discharged to short-term hospitals, other institutions, and care homes.”
Even though most of the readmissions were from noncardiac causes, the authors noted they could have been related to PCI. Nonspecific chest pain was the most common noncardiac diagnosis (14.8 percent) while bleeding complications accounted for 5.9 percent of noncardiac readmissions. The frequency of these issues might be explained by clinicians encouraging patients to get medical attention for chest pain post-PCI, or by patients being placed on powerful blood-thinning drugs following the procedure.
Daniel joined TriMed’s Chicago editorial team in 2017 as a Cardiovascular Business writer. He previously worked as a writer for daily newspapers in North Dakota and Indiana.