Multiple unplanned readmissions after discharge for an admission with percutaneous coronary intervention.
cost
percutaneous coronary intervention
readmissions
Journal
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
ISSN: 1522-726X
Titre abrégé: Catheter Cardiovasc Interv
Pays: United States
ID NLM: 100884139
Informations de publication
Date de publication:
15 02 2021
15 02 2021
Historique:
received:
23
10
2019
revised:
15
01
2020
accepted:
10
02
2020
pubmed:
29
2
2020
medline:
25
9
2021
entrez:
29
2
2020
Statut:
ppublish
Résumé
This study aims to describe temporal trends, characteristics, and clinical outcomes of patients with more than one unplanned readmission within 30 and 180 days after admission with percutaneous coronary intervention (PCI). There is limited understanding of multiple readmissions after PCI. Patients undergoing PCI between 2010 and 2014 in the U.S. Nationwide Readmission Database were evaluated for unplanned readmissions at 30 and 180 days after discharge. Trends in multiple readmissions, characteristics of patients, and causes of first readmissions are described. A total of 2,324,194 patients were included in the analysis of 30-day unplanned readmissions and 1,327,799 patients in the analysis of 180-day unplanned readmission. The proportions of patients with a single readmission and multiple readmissions within 30 days were 8.5 and 1.0% and at 180 days were 15.4 and 9.1%, respectively. Common reasons for first readmission among patients with multiple readmissions were coronary artery disease, including angina, heart failure, and acute myocardial infarction. Factors associated with multiple readmissions were discharge against medical advice, discharge to care home, renal failure, and liver failure. The total cost of multiple readmissions is significant, with an increase from ~$20,000 for no readmission to over $60,000 at 30-day follow up and $86,000 at 180-day follow up. Multiple readmissions are rare within 30 days after PCI but increase to nearly 1 in 10 patients at 180 days, and 20-25% of patients who have multiple readmissions are readmitted for the same cause as for the first and second readmissions.
Sections du résumé
OBJECTIVE
This study aims to describe temporal trends, characteristics, and clinical outcomes of patients with more than one unplanned readmission within 30 and 180 days after admission with percutaneous coronary intervention (PCI).
BACKGROUND
There is limited understanding of multiple readmissions after PCI.
METHODS
Patients undergoing PCI between 2010 and 2014 in the U.S. Nationwide Readmission Database were evaluated for unplanned readmissions at 30 and 180 days after discharge. Trends in multiple readmissions, characteristics of patients, and causes of first readmissions are described.
RESULTS
A total of 2,324,194 patients were included in the analysis of 30-day unplanned readmissions and 1,327,799 patients in the analysis of 180-day unplanned readmission. The proportions of patients with a single readmission and multiple readmissions within 30 days were 8.5 and 1.0% and at 180 days were 15.4 and 9.1%, respectively. Common reasons for first readmission among patients with multiple readmissions were coronary artery disease, including angina, heart failure, and acute myocardial infarction. Factors associated with multiple readmissions were discharge against medical advice, discharge to care home, renal failure, and liver failure. The total cost of multiple readmissions is significant, with an increase from ~$20,000 for no readmission to over $60,000 at 30-day follow up and $86,000 at 180-day follow up.
CONCLUSIONS
Multiple readmissions are rare within 30 days after PCI but increase to nearly 1 in 10 patients at 180 days, and 20-25% of patients who have multiple readmissions are readmitted for the same cause as for the first and second readmissions.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
395-408Informations de copyright
© 2020 Wiley Periodicals, Inc.
Références
Stuntz M, Palak A. Recent trends in percutaneous coronary intervention volume in the United States. Value Health. 2016;19:A347.
Stathopoulos I, Jimenez M, Panagopoulos G, et al. The decline in PCI complication rate: 2003-2006 versus 1999-2002. Hellenic J Cardiol. 2009;50:379-387.
Valle JA, Smith DE, Booher AM, Menees DS, Gurm HS. Cause and circumstance of in-hospital mortality among patients undergoing contemporary percutaneous coronary intervention. Circ Cardiovasc Qual Outcomes. 2012;5:229-235.
Kwok CS, Shah B, Al-Suwaidi J, et al. Timing and causes of unplanned readmissions after percutaneous coronary intervention. JACC Cardiovasc Interv. 2019;12:734-748.
Kwok CS, Rao SV, Potts JE, et al. Burden of 30-day readmissions after percutaneous coronary intervention in 833,344 patients in the United States: predictors, causes and cost: insights from the Nationwide Readmission Database. JACC Cardiovasc Interv. 2019;11:665-674.
Tripathi A, Abbott JD, Fonarow GC, et al. Thirty-day readmission rate and costs after percutaneous coronary intervention in the United States: a national readmissions database analysis. Circ Cardiovasc Interv. 2017;10:e005925. https://doi.org/10.1161/CIRCINTERVENTIONS.117.005925.
Kwok CS, Potts J, Gulati M, et al. Effect of gender on unplanned readmissions after percutaneous coronary intervention (from the Nationwide readmissions database). Am J Cardiol. 2018;121:810-817.
Kwok CS, Rao SV, Gilchrist I, et al. Relation between age and unplanned readmissions after percutaneous coronary intervention (finding from the Nationwide Readmission Database). Am J Cardiol. 2018;122:220-228.
Kwok CS, Narain A, Pascha HM, et al. Readmissions to hospital after percutaneous coronary intervention: a systematic review and meta-analysis of factors associated with readmissions. Cardiovasc Revasc Med. 2019. https://doi.org/10.1016/j.carrev.2019.05.016.
Kwok CS, Hulme W, Olier I, Holroyd E, Mamas MA. Review of early hospitalization after percutaneous coronary intervention. Int J Cardiol. 2017;227:370-377.
NRD Overview. Healthcare Cost and Utilization Project (HCUP). 2019. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/nrdoverview.jsp.
Kwok CS, Martinez SC, Pancholy S, et al. Effect of comorbidity on unplanned readmissions after percutaneous coronary intervention. Sci Rep. 2018;8:11156.
Kwok CS, Bell M, Anderson V, et al. Discharge against medical advice after percutaneous coronary intervention in the United States. JACC Cardiovasc Interv. 2018;11:1354-1364.
Potts JE, Iliescu CA, Lopez Mattei JC, et al. Percutaneous coronary intervention in cancer patients: a report of the prevalence and outcomes in the United States. Eur Heart J. 2019;40:1790-1800.
Wasfy JH, Strom JB, Waldo SW, et al. Clinical preventability of 30-day readmissions after percutaneous coronary intervention. J Am Heart Assoc. 2014;3:e001290.
Tanguturi VK, Temin E, Yeh RW, et al. Clinical interventions to reduce preventable hospital readmissions after percutaneous coronary intervention. Circ Cardiovasc Qual Outcome. 2016;9:600-604.
National Association of Community Health Centers. Access is the answer: community health centers. Primary Care & the Future of American Health Care. http://www.nhchc.org/wp-content/uploads/2013/04/nachc-access-is-answer-brief.pdf. Accessed March 2014.
Lewin Group. Cardiovascular workforce assessment. 2009. http://jaccjacc.cardiosource.com/acc_documents/Adobe%20PDF%20-%20Cardiovascular_Workforce_Assessment--Final_Report.pdf.
Gruca TS, Pyo TH, Nelson GC. Providing cardiology care in rural areas through visiting consultant clinics. J Am Heart Assoc. 2016;5(7):e002909.
Kwok CS, Rao SV, Gilchrist IC Sr, et al. Relation of length of stay to unplanned readmissions for patients who undergo elective percutaneous coronary intervention. Am J Cardiol. 2019;123:33-43.