TCT: PCI risk score may help curb costs, readmissions

Hospitals that want to reduce costs and readmission rates may find a new ally in the form of an easy-to-use risk score that identifies low-risk STEMI patients, according to results of an Oct. 23 poster presentation at the 2012 Transcatheter Cardiovascular Therapeutics (TCT) conference in Miami.

Patients in the U.S. admitted to a hospital for an MI are more likely to have a shorter stay than their counterparts in other countries and are more likely to be readmitted within 30 days (JAMA 2012;307:66-74). The median length of stay in the U.S. is three days, five days less than an MI hospitalization in Germany, for instance. In comparison with 16 other countries, the risk of readmission within 30 days is much higher for U.S. patients—at a 68 percent increased odds of rehospitalization.

In an effort to lower costs, Medicare has placed MI readmissions in its crosshairs with a program that penalizes hospitals for worse-than expected rates for preventable readmission for acute MI.  As a consequence, hospitals are looking for evidence-based approaches that lower readmission rates without compromising patient care.

Timothy D. Henry, MD, an interventional cardiologist at the Minneapolis Heart Institute at Abbott Northwestern Hospital in Minneapolis, and colleagues tested one such possible approach, the use of the Zwolle PCI Risk Index Scoring System, a validated score that identifies low-risk STEMI patients for early discharge. For their analysis, they retrospectively applied the scoring system to nearly 1,000 STEMI patients who presented at their facility between January 2009 and December 2011. Patients were grouped as either low risk, with scores of 0 to 3 (56 percent of the cohort), or high risk, with scores of 4 or greater (44 percent).

“We applied it to the whole patient population.” Henry said, who also is the director of research at the Minneapolis Heart Institute Foundation. “We were not selective.”

The high risk group tended to be older, had more hypertension, diabetes and previous coronary artery disease; were more likely to have previous PCI and CABG; and had lower left ventricular ejection fractions. Their in-hospital mortality and in-hospital complication rates were much higher than the low-risk group, at 11.9 percent vs. 0 percent, and 17.1 percent vs. 6.5 percent, respectively.

They also had higher median lengths of stay as well as higher rates of 30-day and one-year mortality.

The researchers concluded that the Zwolle PCI Risk Index Scoring System identified low-risk STEMI patients after PCI, and that it could be used to safely discharge low-risk patients. In a release, the institute calculated that one day of early discharge could save $7,000 in hospital costs.

The risk scoring system can be applied in other hospital settings, Henry said, adding that his facility plans to implement the system into its protocol next year as part of its quality initiatives.  

“When a patient finishes an angiogram, the risk score will be calculated,” he said. “If the patient is low risk, instead of going to the coronary care unit, he or she will go the post-PCI unit and will be put on an accelerated discharge.” The goal will be to discharge these low-risk patients within 36 to 48 hour, he said.