Author + information
- Received February 21, 2018
- Revision received March 14, 2018
- Accepted March 20, 2018
- Published online July 16, 2018.
- Chun Shing Kwok, MBBS, MSc, BSca,b,
- Malcolm Bell, MDc,
- H. Vernon Anderson, MDd,
- Khaled Al Shaibi, MBChBe,
- Rajiv Gulati, MDc,
- Jessica Potts, MSca,
- Muhammad Rashid, MBBSa,
- Evangelos Kontopantelis, PhDf,
- Rodrigo Bagur, MDa and
- Mamas A. Mamas, BMBCh, DPhila,b,∗ ()
- aKeele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom
- bDepartment of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, United Kingdom
- cDepartment of Cardiology, Mayo Clinic, Rochester, New York
- dDepartment of Cardiology, University of Texas Health Science Center, Houston, Texas
- eDepartment of Cardiology, King Fahd Armed Forces Hospital, Saudi Arabia
- fDivision of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- ↵∗Address for correspondence:
Prof. Mamas A. Mamas, Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom.
Objectives This study aimed to evaluate discharge against medical advice (DAMA) in percutaneous coronary intervention (PCI) and how DAMA affects readmissions.
Background DAMA is infrequent but associated with poor patient outcomes. DAMA in the context of PCI has not been described in the published reports.
Methods The authors analyzed patients in the Nationwide Readmission Database between 2010 and 2014 with a PCI procedure who were either discharged home or against medical advice. The primary endpoint was all-cause 30-day readmissions and their causes. Descriptive statistics were used to compare DAMA with patients discharged home, and multiple logistic regressions were used to determine patient characteristics associated with DAMA and readmission.
Results Among the 2,021,104 patients in the analysis, the proportion of patients who DAMA was 0.5% (n = 10,049). The 30-day readmission rate for patients who were DAMA and those discharged home was 16.8% and 8.5%, respectively (p < 0.001). Important predictors of DAMA included diagnosis of acute myocardial infarction (odds ratio [OR]: 1.37; 95% confidence interval [CI]: 1.25 to 1.51; p < 0.001), smoking (OR: 1.71; 95% CI: 1.57 to 1.86; p < 0.001), drug abuse (OR: 1.82; 95% CI: 1.60 to 2.06; p < 0.001), and alcohol misuse (OR: 1.53; 95% CI: 1.32 to 1.78; p < 0.001). DAMA was the strongest predictor for readmission (OR: 1.89; 95% CI: 1.71 to 2.08; p < 0.001). DAMA patients were more likely to have neuropsychiatric reasons for noncardiac causes of readmission (8.3% vs. 2.4%) and acute myocardial infarction for cardiac causes of readmission (39.4% vs. 19.5%) compared with patients discharged home.
Conclusions DAMA occurs in approximately 0.5% of patients following PCI and is strongly associated with readmission within 30 days. Interventions should be developed to reduce DAMA in high-risk groups and initiate interventions to avoid complications and readmission when it occurs.
The study was supported by a grant from the Research and Development Department at the Royal Stoke Hospital. This work is conducted as a part of Dr. Kwok’s PhD, which is supported by Biosensors International. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 21, 2018.
- Revision received March 14, 2018.
- Accepted March 20, 2018.
- 2018 American College of Cardiology Foundation