The Frequency of and Reasons for Hospital Readmission Post Percutaneous Coronary Intervention
DOI:
https://doi.org/10.1891/1748-6254.13.1.24Keywords:
PCI, hospital readmissions, complications, follow-upAbstract
Objectives: The objective of this study was to determine the frequency of and reasons for six months unplanned readmission to hospital post Percutaneous Coronary Intervention (PCI).
Background: PCI has become an important and effective way of treating heart disease; however the occurrence of hospital readmission post PCI is not well documented.
Methods: The frequency of hospital readmissions were tracked for six months following PCI using the APPROACH registry database. The incidence of and reasons for hospital readmission were determined using the Capital Health Region Administrative Database and the ICD-10 coding for hospital readmission.
Results: Of 2641 subjects, it was observed that 4.5% of patients were readmitted to hospital within six months of PCI and 18.6% of patients visited the ED for reasons directly related to PCI. The top reasons for readmission were chest pain (31.2%), atherosclerotic heart disease (24.3%), bleeding/complications with anticoagulation (10.9%), myocardial infarction (7.5%) and procedural complications (3.7%). Factors shown to be independent predictors of hospital readmission were congestive heart failure (p = 0.009), pulmonary disease (p = 0.008), malignancy (p = 0.002), liver disease (p = 0.012) and female gender (p = 0.015).
Conclusions: The data indicates that while in-patient six months unplanned hospital readmission post PCI is relatively low, ED visits are substantial. The creation of a post PCI clinic and/or a post PCI hotline may prove to be useful in decreasing hospital visits post PCI. If patients are routinely followed up in the early post PCI period, access to health care may be improved, allowing complications to be observed sooner and care to be given quicker.
References
Ashton, C. M., Kuykendall, D. H., Johnson, M. L., Wray, N. P., & Wu, L. (1995). The association between the quality of inpatient care and early readmission. Annals of Internal Medicine, 122(6), 415–421.
Dendale, P., Berger, J., Hansen, D., Vaes, J., Benit, E., & Weymans, M. (2005). Cardiac rehabilitation reduces the rate of major adverse cardiac events after percutaneous coronary intervention. European Journal of Cardiovascular Nursing, 4(2), 113–116.
Fransson, S. G., & Nylander, E. (1994). Vascular injury following cardiac catheterization, coronary angiography, and coronary angioplasty. European Heart Journal, 15(2), 232–235.
Galan, K. M., Gruentzig, A. R., & Hollman, J. (1985). Significance of early chest pain after coronary angioplasty. Heart & Lung: The Journal of Critical Care, 14(2), 109–112.
Ghali, W. A. (2001). Comparison of 2 methods for calculating adjusted survival curves from proportional hazards models. JAMA, 286, 1494–1497.
Khawaja, F. J., Shah, N. D., Lennon, R. J., Slusser, J. P., Alkatib, A. A., Rihal, C. S., & Curtis, J. P. (2012). Factors associated with 30-day readmission rates after percutaneous coronary intervention. Archives of Internal Medicine, 172(2), 112–117.
Halon, D. A., Rennert, H. S., Flugelman, M. Y., Jaffe, R., & Lewis, B. S. (2002). Burden of late repeat hospitalization in patients undergoing angioplasty or bypass surgery. Cardiology, 98(1-2), 67–74.
Hannan, E. L., Zhong, Y., Krumholz, H., Walford, G., Holmes, D. R., Stamato, N. J., & King, S. B. (2011). 30-day readmission for patients undergoing percutaneous coronary interventions in New York state. JACC: Cardiovascular Interventions, 4(12), 1335–1342.
Healy, P. (2004). Patients like angioplasty phone follow-up service. Nursing Standard, 18(52), 7.
Heggestad, T., & Lilleeng, S. E. (2003). Measuring readmissions: Focus on the time factor. International Journal for Quality in Health Care, 15(2), 147–154.
Krumholz, H. M. (2013). Post-hospital syndrome—an acquired, transient condition of generalized risk. New England Journal of Medicine, 368(2), 100–102.
Kuchulakanti, P. K., Satler, L. F., Suddath, W. O., Pichard, A. D., Kent, K. M., Pakala, R., & Waksman, R. (2004). Vascular complications following coronary intervention correlate with long-term cardiac events. Catheterization and Cardiovascular Interventions, 62(2), 181–185.
Kwok, C. S., Martinez, S. C., Pancholy, S., Ahmed, W., Al-Shaibi, K., Potts, J., & Mamas, M. A. (2018). Effect of comorbidity on unplanned readmissions after percutaneous coronary intervention (from the nationwide readmission database). Scientific Reports, 8. doi: 10.1038/s41598-018-29303-y
Laskey, W. K., Selzer, F., Jacobs, A. K., Cohen, H. A., HolmesJr, D. R., Wilensky, R. L., … NHLBI Dynamic Registry Investigators. (2005). Importance of the postdischarge interval in assessing major adverse clinical event rates following percutaneous coronary intervention. The American Journal of Cardiology, 95(10), 1135–1139.
Linsay, P., Sherrard, H., Adam, M., & Wicha, C. (2000). The impact of a nurse-managed clinic for PTCA patient follow-up. Canadian Journal of Cardiovascular Nursing, 11(1), 13–20.
Linton, M. F., & Fazio, S. (2003). A practical approach to risk assessment to prevent coronary artery disease and its complications. The American Journal of Cardiology, 92(1), 19–26.
Lubitz, J. D., Gornick, M. E., Mentnech, R. M., & Loop, F. D. (1993). Rehospitalizations after coronary revascularization among Medicare beneficiaries. American Journal of Cardiology, 72(1), 26–30.
Moretti, C., Meynet, I., D'ascenzo, F., Omedè, P., Barbero, U., Quadri, G., & Gaita, F. (2015). Sixty-day readmission rate after percutaneous coronary intervention: Predictors and impact on long-term outcomes. European Heart Journal–Quality of Care and Clinical Outcomes, 1(2), 79–84.
Olsen, J., & Coleman, J. R. (2001). Using continuous quality improvement techniques to determine the causes of hospital readmission. Critical Care Nurse, 21(2), 52.
Quan, H., Parsons, G. A., & Ghali, W. A. (2002). Validity of information on comorbidity derived from ICD-9-CCM administrative data. Medical Care, 40(8), 675–685.
Rashid, M., Kwok, C. S., Gale, C. P., Doherty, P., Olier, I., Sperrin, M., & Mamas, M. A. (2016). Impact of co-morbid burden on mortality in patients with coronary heart disease, heart failure, and cerebrovascular accident: A systematic review and meta-analysis. European Heart Journal–Quality of Care and Clinical Outcomes, 3(1), 20–36.
Ricci, M. A., Trevisani, G. T., & Pilcher, D. B. (1994). Vascular complications of cardiac catheterization. The American Journal of Surgery, 167(4), 375–378.
Ricciardi, M. J., Selzer, F., Marroquin, O. C., Holper, E. M., Venkitachalam, L., Williams, D. O., & Laskey, W. K. (2012). Incidence and predictors of 30-day hospital readmission rate following percutaneous coronary intervention (from the national heart, lung, and blood institute dynamic registry). The American Journal of Cardiology, 110(10), 1389–1396.
Sherev, D. A., Shaw, R. E., & Brent, B. N. (2005). Angiographic predictors of femoral access site complications: Implication for planned percutaneous coronary intervention. Catheterization and Cardiovascular Interventions, 65(2), 196–202.
Smith, Jr, S. C. (2001). ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines)—executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty) endorsed by the Society for Cardiac Angiography and Interventions. Circulation, 103, 3019–3044.
Tan, K. H., Sule, N., Taub, N., & Sowton, E. (1995). Predictors of angiographic findings when chest pain recurs after successful coronary angioplasty. European Heart Journal, 16(11), 1593–1602.
Van Walraven, C., Mamdani, M., Fang, J., & Austin, P. C. (2004). Continuity of care and patient outcomes after hospital discharge. Journal of General Internal Medicine, 19(6), 624–631.
Velders, M. A., James, S. K., Libungan, B., Sarno, G., Fröbert, O., Carlsson, J., & Lagerqvist, B. (2014). Prognosis of elderly patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention in 2001 to 2011: A report from the Swedish coronary angiography and angioplasty registry (SCAAR) registry. American Heart Journal, 167(5), 666–673.
Versaci, F., Gaspardone, A., Tomai, F., Proietti, I., Crea, F., Chiariello, L., & Gioffrè, P. A. (2002). Chest pain after coronary artery stent implantation. The American Journal of Cardiology, 89(5), 500–504.
Wasfy, J. H., Rosenfield, K., Zelevinsky, K., Sakhuja, R., Lovett, A., Spertus, J. A., & Yeh, R. W. (2013). A prediction model to identify patients at high risk for 30-day readmission after percutaneous coronary intervention. Circulation: Cardiovascular Quality and Outcomes, 6(4), 429–435. doi:10.1161/CIRCOUTCOMES.111.000093
Wasfy, J. H., Strom, J. B., O'brien, C., Zai, A. H., Luttrell, J., Kennedy, K. F., & Yeh, R. W. (2014). Causes of short-term readmission after percutaneous coronary intervention. Circulation: Cardiovascular Interventions, 7(1), 97–103. doi:10.1161/CIRCINTERVENTIONS.113.000988
Weinberger, M., Oddone, E. Z., & Henderson, W. G. (1996). Does increased access to primary care reduce hospital readmissions?New England Journal of Medicine, 334(22), 1441–1447.
Yeh, R. W., Rosenfield, K., Zelevinsky, K., Mauri, L., Sakhuja, R., Shivapour, D. M., & Normand, S. L. T. (2012). Sources of hospital variation in short-term readmission rates after percutaneous coronary intervention. Circulation: Cardiovascular Interventions, 5(2), 227–236. doi:10.1161/CIRCINTERVENTIONS.111.967638
Yost, G. W., Puher, S. L., Graham, J., Scott, T. D., Skelding, K. A., Berger, P. B., & Blankenship, J. C. (2013). Readmission in the 30 days after percutaneous coronary intervention. JACC: Cardiovascular Interventions, 6(3), 237–244.
