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Consequences of 30-Day Readmission After PCI Found Dire at 1 Year
Hernandez AF. Arch Intern Med.
2011;doi:10.1001/archinternmed.2011.568.
Khawaja FJ. Arch Intern Med.
2011;doi:10.1001/archinternmed.2011.569.
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For the nearly one in 10 patients who were readmitted within 30 days of undergoing PCI in a recent study, 1-year mortality was significantly higher when compared with patients who were not readmitted.
Researchers examined 15,498 patients who underwent PCI at Saint Marys Hospital in Rochester, Minn., between January 1998 and June 2008.
Within 30 days of the procedure, 9.4% were readmitted to the hospital, 69% of whom were readmitted for cardiac-related reasons. Overall, 4.2% of patients had repeated PCI within 30 days of discharge and 8.9% had PCI or CABG within 30 days of discharge. Thirty-day mortality was 0.68%.
After multivariate analysis, 30-day readmission was significantly associated with 1-year mortality (HR=1.38; 95% CI, 1.08-1.75). Additional results indicated the following demographic factors were associated with an increased risk of 30-day readmission: female sex (OR=1.32; 95% CI, 1.17-1.48), Medicare insurance (OR=1.20; 95% CI, 1.01-1.43) and less than a high school education (OR=1.35; 95% CI, 1.17-1.55).
Adrian F. Hernandez, MD, MHS, and Christopher B. Granger, MD, both of the Duke Clinical Research Institute at Duke University Medical Center, Durham, N.C., wrote in accompanying editorial that to reduce readmission, better evidence on effective approaches that address health systems shortcomings, specifically identifying and intervening in the most vulnerable patients, is needed.
“Early outpatient follow-up may be a strategy to reduce readmissions but other interventions will be necessary for this complex, multifaceted problem,” they wrote. “Understanding the common issues between PCI readmissions vs. other medical or surgical conditions will be necessary to have broad-based solutions. The challenge is determining what, if any, of these solutions will reduce readmissions and improve overall quality of care during this period of patient vulnerability and fragmented care.”
Disclosure: Dr. Granger has received research support or consulting fees from Astellas Pharma US, AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, Hoffman-La Roche, Eli Lilly, Medtronic Vascular, Merck, Novartis Pharmaceutical, Otsuka Pharmaceutical Development & Commercialization, Sanofi-Aventis and The Medicines Company; Dr. Hernandez has received research support or consulting fees from AstraZeneca, Johnson & Johnson, Medtronic, Novartis Pharmaceutical, Proventys, Scios and Thoratec Corp.
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Understanding the reasons why patients are readmitted could have important implications on cost of care, as well as long-term mortality, if modifiable factors can be identified. However, as the researchers admit, most of the factors related to readmission were non-modifiable. A quick look through the list of factors related to readmission shows that most of them reflect higher comorbidities related to poor outcomes or higher-risk or complicated procedures. Although their prediction model has modest discrimination, it is unlikely that this could be used in risk stratification, as the absolute differences between the risk factors are pretty small. However, it is important data for reinforcing our understanding of the factors related to readmission. This paper forms a basis for future studies that could test strategies to prevent the causes of readmission, perhaps in high-risk groups identified by variables in this study.
– Scott Kinlay, MBBS, PhD
Cardiology
Today Intervention Editorial Board member
Disclosure: Dr.
Kinlay reports no relevant financial disclosures.