Author + information
- Received October 11, 2017
- Revision received December 18, 2017
- Accepted January 9, 2018
- Published online April 2, 2018.
- Chun Shing Kwok, MBBS, MSc, BSca,b,∗ (, )
- Sunil V. Rao, MDc,
- Jessica E. Potts, MSca,
- Evangelos Kontopantelis, PhDd,
- Muhammad Rashid, MBBSa,
- Tim Kinnaird, MDe,
- Nick Curzen, BM, PhDf,
- James Nolan, MDa,b,
- Rodrigo Bagur, MD, PhDg and
- Mamas A. Mamas, BMBCh, DPhila,b
- aCentre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom
- bRoyal Stoke University Hospital, Stoke-on-Trent, United Kingdom
- cDepartment of Cardiology, Duke Clinical Research Institute, Durham, North Carolina
- dUniversity of Manchester, Manchester, United Kingdom
- eDepartment of Cardiology, University Hospital of Wales, Cardiff, United Kingdom
- fUniversity Hospital Southampton NHS Foundation Trust & Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- gDivision of Cardiology, Department of Medicine, London Health Sciences Centre, and Epidemiology and Biostatistics, Western University, London, Canada
- ↵∗Address for correspondence:
Dr. Chun Shing Kwok, Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Stoke-on-Trent ST4 7QB, United Kingdom.
Objectives This study aimed to examine the 30-day unplanned readmissions rate, predictors of readmission, causes of readmissions, and clinical impact of readmissions after percutaneous coronary intervention (PCI).
Background Unplanned rehospitalizations following PCI carry significant burden to both patients and the local health care economy and are increasingly considered as an indicator of quality of care.
Methods Patients undergoing PCI between 2013 and 2014 in the U.S. Nationwide Readmission Database were included. Incidence, predictors, causes, and cost of 30-day unplanned readmissions were determined.
Results A total of 833,344 patients with PCI were included, of whom 77,982 (9.3%) had an unplanned readmission within 30 days. Length of stay for the index PCI was greater (4.7 vs. 3.9 days) and mean total hospital cost ($23,211 vs. $37,524) was higher for patients who were readmitted compared with those not readmitted. The factors strongly independently associated with readmissions were index hospitalization discharge against medical advice (odds ratio [OR]: 1.91; 95% confidence interval [CI]: 1.65 to 2.22), transfer to short-term hospital for inpatient care (OR: 1.62; 95% CI: 1.38 to 1.90), discharge to care home (OR: 1.57; 95% CI: 1.51 to 1.64), and chronic kidney disease (OR: 1.50; 95% CI: 1.44 to 1.55). Charlson Comorbidity Index score (OR: 1.28; 95% CI: 1.27 to 1.29) and number of comorbidities (OR: 1.18; 95% CI: 1.17 to 1.18) were independently associated with unplanned readmission. The majority of readmissions were due to noncardiac causes (56.1%).
Conclusions Thirty-day readmissions after PCI are relatively common and relate to baseline comorbidities and place of discharge. More than one-half of the readmissions were due to noncardiac causes.
Financial support was provided by the North Staffs Heart Committee. This work was conducted as a part of Dr. Kwok’s PhD research, which was supported by Biosensors International. Dr. Curzen has received unrestricted research grant support from Boston Scientific, Haemonetics, Heartflow, and Philips Volcano; has received speaker fees from Boston Scientific and Heartflow; has received travel sponsorship from Edwards and Lilly/D-S; and has served as a consultant for Haemonetics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 11, 2017.
- Revision received December 18, 2017.
- Accepted January 9, 2018.
- 2018 American College of Cardiology Foundation