Avnish Tripathi1, J Dawn Abbott1, Gregg C Fonarow1, Abdur R Khan1, Neil G Barry1, Sohail Ikram1, Rita Coram1, Verghese Mathew1, Ajay J Kirtane1, Brahmajee K Nallamothu1, Glenn A Hirsch1, Deepak L Bhatt2. 1. From the Division of Cardiology, University of Louisville Medical School, KY (A.T., A.R.K., N.G.B., S.I., R.C., G.A.H.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (J.D.A.); Division of Cardiology, David Geffen School of Medicine, UCLA, Los Angeles, CA (G.C.F.); Division of Cardiology, Stritch School of Medicine, Loyola University, Chicago, IL (V.M.); Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital (A.J.K.); Department of Internal Medicine, University of Michigan, Ann Arbor (B.K.N.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.). 2. From the Division of Cardiology, University of Louisville Medical School, KY (A.T., A.R.K., N.G.B., S.I., R.C., G.A.H.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (J.D.A.); Division of Cardiology, David Geffen School of Medicine, UCLA, Los Angeles, CA (G.C.F.); Division of Cardiology, Stritch School of Medicine, Loyola University, Chicago, IL (V.M.); Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital (A.J.K.); Department of Internal Medicine, University of Michigan, Ann Arbor (B.K.N.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.). dlbhattmd@post.harvard.edu.
Abstract
BACKGROUND: The association of short-term readmissions after percutaneous coronary intervention (PCI) on healthcare costs has not been well studied. METHODS AND RESULTS: The Healthcare Cost and Utilization Project National Readmission Database encompassing 722 US hospitals was used to identify index PCI cases in patients ≥18 years old. Hierarchical regression analyses were used to examine the factors associated with risk of 30-day readmission and higher cumulative costs. We evaluated 206 869 hospitalized patients who survived to discharge after PCI from January through November 2013 and analyzed readmissions over 30 days after discharge. A total of 24 889 patients (12%) were readmitted within 30 days, with rates ranging from 6% to 17% across hospitals. Among the readmitted patients, 13% had PCI, 2% had coronary artery bypass surgery, and 3% died during the readmission. The most common reasons for readmission included nonspecific chest pain/angina (24%) and heart failure (11%). Mean cumulative costs were higher for those with readmissions ($39 634 versus $22 058; P<0.001). The multivariable analyses showed that readmission increased the log10 cumulative costs by 45% (β: 0.445; P<0.001). There was no significant difference in cumulative costs by the type of insurance. CONCLUSIONS: In a national sample of inpatient PCI cases, 30-day readmissions were associated with a significant increase in cumulative costs. The majority of readmissions were because of low-risk chest pain that did not require any intervention. Ongoing effort is warranted to recognize and mitigate potentially preventable post-PCI readmissions.
BACKGROUND: The association of short-term readmissions after percutaneous coronary intervention (PCI) on healthcare costs has not been well studied. METHODS AND RESULTS: The Healthcare Cost and Utilization Project National Readmission Database encompassing 722 US hospitals was used to identify index PCI cases in patients ≥18 years old. Hierarchical regression analyses were used to examine the factors associated with risk of 30-day readmission and higher cumulative costs. We evaluated 206 869 hospitalized patients who survived to discharge after PCI from January through November 2013 and analyzed readmissions over 30 days after discharge. A total of 24 889 patients (12%) were readmitted within 30 days, with rates ranging from 6% to 17% across hospitals. Among the readmitted patients, 13% had PCI, 2% had coronary artery bypass surgery, and 3% died during the readmission. The most common reasons for readmission included nonspecific chest pain/angina (24%) and heart failure (11%). Mean cumulative costs were higher for those with readmissions ($39 634 versus $22 058; P<0.001). The multivariable analyses showed that readmission increased the log10 cumulative costs by 45% (β: 0.445; P<0.001). There was no significant difference in cumulative costs by the type of insurance. CONCLUSIONS: In a national sample of inpatient PCI cases, 30-day readmissions were associated with a significant increase in cumulative costs. The majority of readmissions were because of low-risk chest pain that did not require any intervention. Ongoing effort is warranted to recognize and mitigate potentially preventable post-PCI readmissions.
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