Hospital readmission associated with higher mortality among PCI patients

Patients readmitted to the hospital within 30 days after percutaneous coronary intervention were at a higher risk for death at 1 year compared with patients who were not readmitted, new data suggest.

Of 15,498 patients who underwent PCI at Saint Marys Hospital in Rochester, Minn., from January 1998 to June 2008, 9.4% were readmitted to the hospital within 30 days after the procedure. Sixty-nine percent were readmitted for cardiac-related reasons, researchers said, with 4.2% having repeated PCI within 30 days of discharge and 8.9% having PCI or CABG within 30 days of discharge.

Of all patients, 0.68% died within 30 days after the procedure, with 33 deaths occurring during or after readmission to the hospital. Seventy-three deaths were not associated with readmission, according to the researchers.

Risk for readmission

Researchers found that the following patients had an increased risk for 30-day readmission to the hospital after PCI:

• Women (OR=1.32; 95% CI, 1.17-1.48).
• Medicare patients (OR=1.20; 95% CI, 1.01-1.43).
• Patients with less than a high school education (OR=1.35; 95% CI, 1.17-1.55).
• Patients with congestive HF (OR=1.36; 95% CI, 1.12-154).
• Patients with peptic ulcer disease (OR=1.29; 95% CI, 1.05-1.59).
• Patients with metastatic cancer (OR=1.92; 95% CI, 1.19-3.09).
• Patients with a length of hospital stay longer than 3 days (OR=1.59; 95% CI, 1.37-1.84).

One-year mortality was higher among patients who were readmitted to the hospital within 30 days after PCI, according to study data.

Prevention efforts

Different opportunities to prevent readmission have been tried, but they have only shown mixed effects, without clearly defined success strategies, according to Adrian F. Hernandez, MD, MHS, and Christopher B. Granger, MD, both of the Duke Clinical Research Institute at Duke University Medical Center. In an accompanying editorial, they wrote that educating patients regarding medication and lifestyle, communication between medical providers, early follow-up visits and enhanced monitoring for changes that identify opportunities to prevent clinical worsening have been established to improve transitions in care. However, researchers are still unsure which factors are important and how to modify them to reduce readmission.

“In the end, reducing hospital readmission rates by preventing progression of disease and occurrence of events should be a goal of care,” Hernandez and Granger wrote. “To reduce readmissions, we need better evidence on effective approaches that address our health systems’ shortcomings, ideally identifying and intervening in the most vulnerable patients.”

Hernandez and Granger said a combination of these interventions, as well as “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 readmission and improve overall quality of care during this period of patient vulnerability and fragmented care.”

For more information:

• Hernandez AF. Arch Intern Med. 2011;doi:10.1001/archinternmed.2011.568.
• Khawaja FJ. Arch Intern Med. 2011;doi:10.1001/archinternmed.2011.569.

Disclosure: Dr. Hernandez received research support or consulting fees from AstraZeneca, Johnson & Johnson, Medtronic, Novartis Pharmaceutical Co, Proventys, Scios Inc., and Thoratec Corp. Dr. Granger received research support or consulting fees from Astellas Pharma US, AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, Hoffman-La Roche, Lilly, Medtronic Vascular Inc., Merck, Novartis Pharmaceutical, Otsuka Pharmaceutical Development & Commercialization Inc., Sanofi-Aventis and the Medicines Co.

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