Author + information
- Avnish Tripathi,
- J. Abbott,
- Gregg Fonarow,
- Abdur Khan,
- Sadip Pant,
- Sohail Ikram,
- Rita Coram,
- Harsh Golwala,
- Brahmajee Nallamothu and
- Deepak Bhatt
Background: Estimated rates of 30-day readmission after percutaneous coronary interventions (PCI) have been 15–19% in the Medicare population. National estimates of 30-day readmission rates and costs after PCIs have not been thoroughly studied.
Methods: Healthcare Cost and Utilization Project's National Readmission Database to was used identify index PCI cases in ≥ 18 years old. National estimates of 30-day readmission after PCI and associated costs were computed. Hierarchal logistic regression was used to examine the associated factors.
Results: An estimated 467,488 PCIs were performed from January through November 2013 in the United States. 56,154 (12%) had 30-day readmission. Rates varied from 6–17% by hospital deciles of readmissions (p<0.001). Among those readmitted, 13% had repeat PCI and 2% coronary artery bypass surgery; and all-cause mortality was 4%. Primary diagnosis associated with 30-day readmission included 24% angina or nonspecific chest pain; 11% heart failure; 7% acute myocardial infarction and 7% procedure complications. In multivariate analysis, significant predictors of 30-day readmission were: female sex; older age; comorbidities including heart failure, peripheral vascular disease, obstructive pulmonary disease, diabetes mellitus, and chronic kidney disease; longer index hospital stay; and hospital level factors including payor as Medicare/Medicaid compared to private insurance, metropolitan area, and non-teaching hospital status. Mean hospital charge and payment (cost) of index PCI admission were $86,887 (SE $1,494) and $22,586 (SE $316) respectively. For 30-day readmissions mean charge and cost were $50,846 (SE $836) and $13,055 (SE $188) respectively. Estimated national cost of 30-day readmissions was $733 million. In multivariate cost analyses, after controlling for patient and hospital level factors, higher cost was associated with private insurance compared to Medicare or Medicaid (p<0.001)
Conclusions: National estimate of 30-day readmission rate after PCI is lower than previously reported in Medicare population. However, the rates vary significantly among hospitals. Further efforts are warranted to understand preventable causes.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: PCI for NSTEMI and Complex Patients With Multiple Co-Morbidities
Abstract Category: 19. Interventional Cardiology: Complex Patients/Comorbidities
Presentation Number: 1154-134
- 2017 American College of Cardiology Foundation