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Anxiety, ED visits, anticoagulation raise 30-day readmission risk after PCI
Anxiety, ED visits and use of anticoagulation were independently associated with 30-day readmission after PCI, according to data from a review of electronic medical records.
Jason H. Wasfy, MD, MPhil, FACC, and colleagues reviewed records for 9,288 patients who underwent PCI. Patients readmitted within 30 days (cases; n = 888) were matched in a 1:2 with patients who were not readmitted (controls; n = 1776). Data extracted from electronic medical records included unstructured and unconventional structured information on characteristics such as need for medical interpretation, albumin level, medical nonadherence, previous number of ED visits, atrial fibrillation or flutter, syncope or presyncope, end-stage liver disease, malignancy and anxiety.
Jason H. Wasfy
“What we’re doing is a first step towards extracting subjective information from electronic records and leveraging that into something that can predict outcomes in a structured way,” Wasfy, assistant medical director, Massachusetts General Physicians Organization, said in an interview with Cardiology Today.
Wasfy and colleagues compared the rates of those characteristics between cases and controls and estimated their association with 30-day readmission.
Differences in seven factors
In univariate analyses, they found differences between the groups in the following characteristics:
- need for interpretation: cases, 7.9%; controls, 5.3%; (P = .009);
- ED visits: cases, 1.12; controls, 0.77; (P < .001);
- homelessness: cases, 3.2%; controls, 1.6%; (P = .007);
- anticoagulation: cases, 33.9%; controls, 22.1%; (P < .001);
- AF or atrial flutter: cases, 32.7%; controls, 28.9%; (P = .045);
- presyncope or syncope: cases, 27.8%; controls, 21.3%; (P < .001); and
- anxiety: cases, 69.4%; controls, 62.4%; (P < .001).
After adjustment, they found that anxiety (OR = 1.26; 95% CI, 1.04-1.53), number of ED visits (OR = 1.07; 95% CI, 1.02-1.13) and anticoagulation use (OR = 1.7; 95% CI, 1.41-2.06) were independently associated with 30-day readmission.
“There are two main lessons,” Wasfy told Cardiology Today. “One is that there are specific variables that are highly predictive of readmission after PCI. In particular, the findings regarding anxiety, previous ED visits and anticoagulation are important because those variables are not typically in registry data. The second lesson is … by doing this, we’re starting to show that extracting unstructured information from medical records in ways that improve care is viable.”
Empowering patients
The anxiety finding is important, Wasfy added, because previous research showed that patients frequently return to the hospital after PCI with low-risk chest pain, and it is “an open question as to whether these are anxious patients who maybe don’t have great access to outpatient cardiologists or if angina is causing them to return. Empowering patients to understand their own symptoms is an extremely important part of the care of these patients. If we can do that better, there are advantages in terms of improving the quality of care and … reducing costs.” – by Erik Swain
For more information:
Jason H. Wasfy, MD, MPhil, FACC, can be reached at Massachusetts General Physicians Organization, BUL-205, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114; email: jwasfy@mgh.harvard.edu.
Disclosure: Wasfy reports consulting for Gilead Sciences and QPID Health. See the full study for a list of the other researchers’ relevant financial disclosures.