Around a quarter of heart patients who undergo percutaneous coronary intervention (PCI) are readmitted to the hospital for unplanned reasons within six months of their procedure, researchers report in JACC: Cardiovascular Interventions.
Chun Shing Kwok, MBBS, MSc, BSc, of the NYU School of Medicine and Keele University in the U.K., and co-authors’ analysis revolved around the rates and causes of readmission for different patients at different time periods after PCI—an important statistic that can reflect a hospital’s care standards and evaluate how health systems are spending their money.
“Unplanned admissions after PCI are important for several reasons,” Kwok and colleagues wrote in JACC. “They may result from actions taken or omitted during the initial hospitalization, such as incomplete treatment or poor-quality care, often reflective of poor coordination among services at the time of discharge or ongoing care.”
They can also be considered an adverse outcome for patients, the authors said, and might represent an unnecessary cost that “drains both bed capacity and financial resources from other hospital services.” Early readmissions are widely recognized as a hospital quality metric, and systems that incur too many could face financial penalties under the Affordable Care Act.
Kwok and colleagues pulled 2010-2014 data from the U.S. Nationwide Readmission Database to study the rates, causes, predictors and costs of unplanned readmissions among 2,412,000 patients who’d undergone PCI. The team looked at readmissions between 0 and 7 days, 8 and 30 days, 31 and 90 days and 91 and 180 days after a patient’s initial hospital discharge.
Readmissions progressed steadily over the six-month period, Kwok et al. said. Broken down, their cumulative findings were as follows:
- 2.5% of patients were readmitted between 0 and 7 days after discharge
- 9.9% of patients were readmitted between 8 and 30 days
- 18% of patients were readmitted between 31 and 90 days
- 24.8% of patients were readmitted between 91 and 180 days
The majority of readmissions during each time period were due to noncardiac causes, the authors said. Nonspecific chest pain was the most common noncardiac cause for readmission, comprising between 14.2% and 22.7% of noncardiac readmissions. Coronary artery disease—including angina—was the most common heart-related cause for readmission (ranging from 37.4% to 39.3% of cardiac readmissions), followed by acute MI in the first week after discharge and heart failure during all subsequent time periods.
“The time point at which patients are at greatest risk is at 7 days post-discharge, with the majority of unplanned readmissions occurring within 30 days,” Kwok and co-authors wrote. “Thereafter, the daily rate of unplanned readmissions declines over time. In addition, the causes of readmission vary depending on the time periods of readmission, with noncardiac chest pain as an important cause at early time points and gastrointestinal bleeding and infections more important at longer time points (91 to 180 days).”
The team said any interventions developed to reduce unplanned admissions should consider the differences in causes of readmission that occur at different time points after discharge for PCI.