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Observational Study
. 2019 Apr 22;12(8):734-748.
doi: 10.1016/j.jcin.2019.02.007. Epub 2019 Mar 27.

Timing and Causes of Unplanned Readmissions After Percutaneous Coronary Intervention: Insights From the Nationwide Readmission Database

Chun Shing Kwok  1 , Binita Shah  2 , Jassim Al-Suwaidi  3 , David L Fischman  4 , Lene Holmvang  5 , Chadi Alraies  6 , Rodrigo Bagur  7 , Vinayak Nagaraja  1 , Muhammad Rashid  7 , Mohamed Mohamed  1 , Glen P Martin  8 , Evan Kontopantelis  8 , Tim Kinnaird  9 , Mamas Mamas  10
Affiliations
Observational Study

Timing and Causes of Unplanned Readmissions After Percutaneous Coronary Intervention: Insights From the Nationwide Readmission Database

Chun Shing Kwok et al. JACC Cardiovasc Interv. .

Abstract

Objectives: The aim of this study was to describe the rates and causes of unplanned readmissions at different time periods following percutaneous coronary intervention (PCI).

Background: The rates and causes of readmission at different time periods after PCI remain incompletely elucidated.

Methods: Patients undergoing PCI between 2010 and 2014 in the U.S. Nationwide Readmission Database were evaluated for the rates, causes, predictors, and costs of unplanned readmission between 0 and 7 days, 8 and 30 days, 31 and 90 days, and 91 and 180 days after index discharge.

Results: This analysis included 2,412,000 patients; 2.5% were readmitted between 0 and 7 days, 7.6% between 8 and 30 days, 8.9% between 31 and 90 days, and 8.0% between 91 and 180 days (cumulative rates 2.5%, 9.9%, 18.0%, and 24.8%, respectively). The majority of readmissions during each time period were due to noncardiac causes (53.1% to 59.6%). Nonspecific chest pain was the most common identifiable noncardiac cause for readmission during each time period (14.2% to 22.7% of noncardiac readmissions). Coronary artery disease including angina was the most common cardiac cause for readmission during each time period (37.4% to 39.3% of cardiac readmissions). The second most common cardiac cause for readmission was acute myocardial infarction between 0 and 7 days (27.6% of cardiac readmissions) and heart failure during all subsequent time periods (22.2% to 23.7% of cardiac readmissions).

Conclusions: Approximately 25% of patients following PCI have unplanned readmissions within 6 months. Causes of readmission depend on the timing at which they are assessed, with noncardiovascular causes becoming more important at longer time points.

Keywords: cost; percutaneous coronary intervention; readmissions.

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Figures

FIGURE 1
FIGURE 1. Flow Diagram of Patient Inclusion
Flow diagram of patients included in the analysis according to timing of unplanned readmissions.
FIGURE 2
FIGURE 2. Rate of Unplanned Readmissions During Different Time Periods
Rates of unplanned readmission within time groups and cumulative rates of unplanned readmissions over time.
FIGURE 3
FIGURE 3. Kaplan-Meier Curve for Cumulative Unplanned Readmissions Over Time
Number of patients without unplanned readmissions over time.
FIGURE 4
FIGURE 4. Rate of Noncardiac Unplanned Readmissions at Different Time Points
Increase in noncardiac unplanned readmissions with increasing time after discharge.
FIGURE 5
FIGURE 5. Causes of Unplanned Readmissions at Different Time Points
Causes of unplanned readmissions at different time points. TIA = transient ischemic attack.
CENTRAL ILLUSTRATION
CENTRAL ILLUSTRATION. Histogram and Temporal Trends According to Time to Unplanned Readmission
Histogram of time to unplanned readmission, with peak rate of readmission at 7 days.
See this image and copyright information in PMC

Comment in

References

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