Author + information
- Esteban Aguayo1,
- Aditya Mantha2,
- Young-Ji Seo3,
- Katherine Bailey3,
- Vishal Dobaria4,
- Yen-Yi Juo5,
- Ramin Ebrahimi6 and
- Peyman Benharash5
- 1UCLA/CDU School of Medicine, Los Angeles, California, United States
- 2University of California Irvine, Orange, California, United States
- 3David Geffen School of Medicine at UCLA, Los Angeles, California, United States
- 4UCLA, Los Angeles, California, United States
- 5David Geffen School of Medicine at UCLA, LOS ANGELES, California, United States
- 6David Geffen School of Medicine UCLA & Veteran's Administration, Los Angeles, California, United States
Readmissions after index hospitalizations comprise a significant portion of rising medical expenditures in the US and are generally associated with worse clinical outcomes. Data on the impact of diabetic ketoacidosis (DKA) on costs, length of stay (LOS) and readmission rates after MI is lacking. In this study we assess impact of DKA on cost, LOS and readmission in diabetic patients post-MI.
Patients with primary diagnosis of myocardial infarction (STEMI/ NSTEMI) and diabetes were identified using the 2010-2014 National Readmission Database (NRD) and the Nationwide Inpatient Sample (NIS) Databases. Analysis was performed in those with readmission data. In hospital and 30-day mortality, readmission within 30 and 60 days of discharge, and GDP-adjusted cost were evaluated using hierarchical linear models adjusting for socioeconomic, demographic and comorbidity measured by Elixhauser Index. Patients were categorized further based upon the diagnosis of DKA.
Of the 414,107 diabetic patients presenting with acute MI, 347 had diabetic ketoacidosis (DKA). Compared to patients with diabetes alone, DKA patients were more likely female (49 vs 41%, p<0.03) and insured by Medicaid (12 vs 7.6%, p<0.04). The cost of care was significantly greater for DKA patients ($36,688 vs $21,345, β=0.33, p<0.001). In-hospital mortality was similar between the groups (6.3 vs 5.6%, OR:1.13, p=NS). Patients with DKA had a significantly longer index length of stay (LOS) (10 vs 5.4 days, p<0.001), LOS during 30 day readmission (8.8 vs 5.6 days, p<0.001), and LOS during 6 month readmission (7.0 vs 5.3 days, p<0.001). Interestingly, DKA patients did not have a significantly greater risk of adjusted all-cause readmission at 30 days (20% vs 17%, OR=1.13, p=NS) or 6 months (39% vs 35% OR=1.08, p=NS). The presence of DKA was associated with a non-significant trend towards increased costs at 30 days ($20,123 vs $14,711, p=NS) and 6 months ($17,309 vs $14,380, p=NS) respectively.
Based on this analysis, DKA disproportionately affected MI patients of female gender and those with government sponsored insurance. Presence of DKA during admission for acute MI was associated with a significantly longer index and repeat hospitalization LOS, but not RR. These findings have significant implications in the era of value-based healthcare delivery. Increased focus on post-discharge care coordination and diabetic management for women and those with government health insurance may have a positive impact on the outcome of MI’s in diabetic patients.
CORONARY: Acute Myocardial Infarction