Readmissions to Hospital After Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis of Factors Associated with Readmissions

Abstract

Background: Readmissions after PCI are a burden to patients and health services that are not well understood.

Methods: A systematic review was performed to identify studies of readmission after PCI. Readmission rates and causes of readmission were examined and factors associated with 30-day readmissions were combined using meta-analyses.

Results: A total of 39 studies evaluated readmissions after PCI (6,569,690 patients, 31 studies). The 30-day readmission rate varied from 3.3%-15.8%. Beyond 30-days, the readmission rate was 6% at 2 months, 31.5% at 6 months, 18.6-50.4% at 12 months and 26.3-71% beyond 48 months. The pooled proportion of patients with cardiac cause for readmissions ranged from 4.6%-75.3%. The range of rates of 30-day readmissions for reinfarction/stent thrombosis, heart failure, chest pain and bleeding were 2.5%-9.5%, 5.9%-12%, 6.7-38.1% and 0.7-7.5%, respectively. Meta-analysis suggests that female gender (RR 1.25(1.20-1.30), I² = 65.2%), diabetes (RR 1.22(1.20-1.25), I² = 0%), heart failure (RR 1.43(CI 1.28-1.60), I² = 92.8%), renal failure (RR 1.50(1.45-1.55), I² = 0%), chronic lung disease (RR 1.34(1.26-1.44), I² = 87.5%), peripheral artery disease (RR 1.20(1.15-1.25), I² = 46.5%) and cancer (RR 1.35(1.15-1.58), I² = 72.8%) were associated with 30-day readmissions. The average cost of unplanned and all 30-day readmissions has been reported to be $12,636 and $17,576, respectively.

Conclusions: We estimate that 1 in 7 patients who undergo PCI are readmitted within 30-days and the rate can rise to up to 3 in 4 patients beyond 3 years. Interventions should be considered to reduce readmissions such as discharge checklists, evaluation of medication compliance at follow-up and prompt management when patients re-present to emergency department.

Keywords: ACS/NSTEMI; Coronary artery disease; Percutaneous coronary interventions.