Author + information
- Dhaval Kolte1,
- Poonam Velagapudi2,
- Kashif Ather1,
- Sahil Khera3,
- Tanush Gupta4,
- Gregg Fonarow5,
- Deepak Bhatt6,
- Herbert Aronow7,
- David Cohen8 and
- J. Dawn Abbott9
- 1Brown University, Providence, Rhode Island, United States
- 2Brown University/Alpert School of Medicine, Columbia, Missouri, United States
- 3Westchester Medical Center, Valhalla, New York, United States
- 4Albert Einstein College of Medicine/ Montefiore Medical Center, Bronx, New York, United States
- 5UCLA, Los Angeles, California, United States
- 6Brigham and Women's Hospital, Boston, Massachusetts, United States
- 7Lifespan Cardiovascular Inst, PROVIDENCE, Rhode Island, United States
- 8Saint Luke's Mid America Heart Institute, Kansas City, Missouri, United States
- 9Brown Medical School, Providence, Rhode Island, United States
Length of stay (LOS) after primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) has decreased over time. However, whether patients discharged early are at increased risk of short-term readmissions remains unknown.
We used the 2014 Nationwide Readmissions Database to identify patients ≥18 years of age who underwent PPCI for STEMI and were discharged home. Cox proportional hazards models were used to determine the association between LOS (1 [ref.], 2, 3, and >3 days] and 30-day unplanned readmissions.
Of 63,939 patients with STEMI who underwent PPCI, LOS was 1, 2, 3, and >3 days in 5,516 (8.6%), 29,416 (46.0%), 17,939 (28.1%), and 11,068 (17.3%), respectively. LOS >3 days was associated with an increased risk of 30-day all-cause or cardiovascular readmissions (Figure). More importantly, there were no significant differences in 30-day readmissions between patients with LOS 1 vs 2 days. Risk-adjusted cost of index hospitalization was $18,082 (95% CI $18,021 - $18,144) and $19,628 (95% CI 19,598 - $19,658) in patients with LOS 1 vs 2 days, a difference of $1,546 (95% CI $1,426 - $1,666). We estimated that if 50% of patients with LOS 2 days could potentially be discharged early on day 1, this would translate into an annual cost saving of $22.7 million (Figure).
In STEMI patients undergoing PPCI, there were no significant differences in 30-day readmission rates between those with index LOS 1 vs 2 days (assuming no difference in mortality). Identifying patients who can be safely discharged home early can result in substantial cost savings.
CORONARY: Acute Myocardial Infarction