Readmission rates following PCI could be nearly halved, according to research published online Sept. 26 in the Journal of the American Heart Association. The key, researchers wrote, starts with changing clinician behaviors.
Calling on patient records from Massachusetts General Hospital and Brigham and Women’s Hospital in Boston, a team led by Jason H. Wasfy, MD, of Harvard Medical School, reviewed 30-day readmissions. They graded readmissions on a scale from 0 to three, from not preventable to definitely preventable.
They found that of the 893 readmissions reviewed, 42.6 percent were preventable. Of the 380 preventable readmissions, Wasfy et al wrote, 34.2 percent could have been prevented by performing an elective procedure during the index admission. Different medical management could have changed outcomes in 28.9 percent of cases.
Wasfy et al wrote that 10.3 percent of readmissions could have been prevented through changes in the procedure, including care for stent-associated dissections. Technical procedure changes could have prevented 9.9 percent of possibly preventable readmissions. Avoiding staged PCI when there were no new symptoms could have prevented 14.7 percent of preventable readmissions.
Better outpatient care could have prevented 10.3 percent of cases. In some cases, a simple check-up could have helped prevent readmissions.
Vascular and bleeding complications made up 10 percent of readmissions and congestive heart failure another 9.7 percent.
“Our results suggest that clinicians and hospitals might reduce readmission rates by avoiding reflexive staged procedures in the absence of new or persistent clinical symptoms, carefully avoiding vascular access complications and bleeding through methods such as transradial access, careful titration of medications for heart failure patients, and minimizing the risk of stent thrombosis through careful technique and intensification of dual antiplatelet therapy in selected high-risk patients,” Wasfy et al noted.
However, their findings also highlighted that 57.4 percent of the cases reviewed were not preventable, although some preventable risks were only partly so.
They found that by improving care, some of these partially preventable risks could be eliminated. Stent thrombosis, syncope/presyncope, careful titration of medications before release and follow-up care post-release were all considered to be areas where improvement could be made that would improve outcomes on the whole.
Also, Wasfy et al noted, that burden for risk of preventable readmissions was a different beast from what made a patient high or low risk in general. For example, a patient at high risk for unpreventable complications was also at high risk for preventable complications. They wrote the mean risk of 30-day readmissions borne across all patients reviewed was 16.9 percent preventable and 16.2 percent nonpreventable. With this in mind the team recommended a focus on doing as much as possible to prevent further risks in already high-risk patients.
Wasfy et al suggested using their findings to improve quality of care for all patients, reducing costs and preventing unnecessary 30-day readmissions across the patient spectrum.