10% of patients readmitted more than once within 6 months after PCI
Nearly 1 in 10 patients are readmitted to the hospital multiple times within 180 days post-PCI and nearly one-quarter of those with multiple readmissions return to the hospital for the same cause each time, according to research published in Catheterization and Cardiovascular Interventions.
Although odds for 30-day readmission remained low, researchers attributed multiple readmissions to factors including discharge against medical advice and discharge to a care home.
Among a cohort of 2,324,194 patients, 8.5% had one readmission and 1% had multiple readmissions at 30 days, whereas among a cohort of 1,327,799 patients, 15.4% had one readmission and 9.1% had multiple readmissions at 180 days.
Factors associated with readmissions
Women were more likely than men to have multiple readmissions at 30 days (OR = 1.18; 95% CI, 1.12-1.25) and 180 days (OR = 1.29; 95% CI, 1.25-1.32), according to the researchers.
In addition, factors strongly associated with multiple readmissions at 180 days included renal failure (OR = 2.03; 95% CI, 1.97-2.1), hospital transfer (OR = 1.86; 95% CI, 1.76-1.96), discharge against medical advice (OR = 1.81; 95% CI, 1.56-2.1) and cancer (OR = 1.76; 95% CI, 1.61-1.93).
Factors associated with multiple 30-day readmissions included discharge against medical advice (OR = 2.76; 95% CI, 2.17-3.49), discharge to care home (OR = 1.68; 95% CI, 1.55-1.84), renal failure (OR = 1.65; 95% CI, 1.55-1.76) and liver failure (OR = 1.62; 95% CI, 1.38-1.89).
“Multiple readmissions are rare within 30 days after PCI but increase to nearly 1 in 10 patients at 180 days,” Chun Shing Kwok, MBBS, MSc, BSc, clinical lecturer in cardiology at Keele University and from the department of cardiology at Royal Stoke University Hospital, U.K., and colleagues wrote. “There is a greater proportion of patients who are older, female, and have more comorbidities who have multiple readmissions, and 20% to 25% of patients who have multiple readmissions are readmitted for the same cause as the first and second readmissions.”
Lower odds and cost of readmission
In other findings, factors associated with decreased odds of both 30-day and 180-day multiple readmissions included patients having private payer insurance (OR = 0.49; 95% CI, 0.45-0.54) and receiving a drug-eluting stent (OR = 0.79; 95% CI, 0.75-0.84).
Researchers also found that cost increased from $20,281 for no readmissions to $62,755 for five readmissions at 30 days post-PCI. At 180 days, the cost increased from $19,958 for no readmissions to $86,365 for five readmissions.
“A key issue related to readmissions is the availability of community services that may care for patients after PCI,” the researchers wrote. “A report by the National Association of Community Health Centers suggests that 62 million Americans have no or inadequate access to primary care due to shortage of physicians. In addition, there is a population of Americans who live in rural areas that may find it challenging to access specialist cardiology services once discharged.
“While more studies are needed to demonstrate that outreach programs reduce hospitalizations, it is likely that better access and integration of hospital and community services would improve patient care and potentially reduce readmissions, especially in the rural population,” the researchers wrote. – by Scott Buzby
Disclosures: The authors report no relevant financial disclosures.