AIM: 1 in 10 PCI patients readmitted within 30 days

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Of the abundant number of patients who undergo a PCI procedure each year, nearly 10 percent are readmitted back to the hospital within 30 days of the procedure, according to a study published online first Nov. 28 in the Archives of Internal Medicine. Readmitted patients also have a higher risk of death within one year.

"Thirty-day readmission rates have become a quality performance measure, and the Centers for Medicare & Medicaid Services (CMS) publicly reports hospital level, 30-day, risk-standardized readmission rates for patients hospitalized with congestive heart failure (CHF), acute myocardial infarction (AMI) and for patients undergoing percutaneous coronary intervention (PCI)," according to the article's background information. While PCI is a commonly performed procedure, the clinical factors associated with readmissions for the procedure remain unknown.

Farhan J. Khawaja, MD, of the Mayo Clinic and Mayo Foundation in Rochester, Minn., and colleagues set out to evaluate factors linked to 30-day readmission, the reasons for readmission and the association of a readmission with one-year mortality. To do so, the researchers analyzed 15,498 PCI hospitalization records (for elective or acute coronary syndromes) that took place between January 1998 and June 2008 at Saint Marys Hospital in Rochester, Minn.

Of the patients who had PCI procedures, 1,459 patients were readmitted to the hospital within 30 days. Within 30 days of the procedure, 106 deaths occurred; 33 deaths during or after a readmission and 73 deaths that were not associated with a readmission.

Khawaja et al reported that female sex, Medicare insurance and unstable angina were some factors linked to hospital readmissions. Additional factors included CHF at hospital presentation, chronic obstructive pulmonary disease, peptic ulcer disease, metastatic cancer and length of stay of more than three days.

Of the reported hospital readmissions, 69 percent were readmitted for cardiac-related reasons and only 4.2 percent had repeat revascularization within 30 days of discharge. Within 30 days of discharge, 8.9 percent had a PCI or CABG procedure.

“Thirty-day risk-standardized readmission rates after PCI have become a publicly reported performance measure, and there is high interest from hospitals and clinicians to understand and improve modifiable factors associated with 30-day readmission rates,” the researchers wrote.

Previously, lack of early follow-up has been linked to increased readmissions for heart failure patients, Khawaja noted. The authors suggested that this could also be linked to the high admission rates seen for PCI patients.

"Lack of early follow-up has been associated with increased risk of readmission among patients with heart failure and may also be playing a role in patients undergoing PCI. Early follow-up allows patients and clinicians to ensure understanding and compliance and to gauge the effectiveness of therapies," the authors wrote.

Education post-procedure remains an important component of care. "Education at the time of discharge and early follow-up also needs to be tailored to patient education level, which has previously been shown to be associated with the risk of readmission among Medicare beneficiaries," the authors summed.

In an accompanying editorial, Adrian F. Hernandez, MD, and Christopher B. Granger, MD, of the Duke University Medical Center in Durham, N.C., wrote that hospitals must focus on reducing rates of readmissions.

Additionally, the editorialists offered that more evidence-based approaches will be necessary to address this gap in care. “Early outpatient follow-up may be a strategy to reduce readmissions but other interventions will be necessary for this complex, multifaceted problem. Understanding the common issues between PCI readmissions vs. other medical or surgical conditions will be necessary to have broad-based solutions,” Hernandez and Granger summed.