Abstract
Patients discharged on oral anticoagulant (OAC) therapy after percutaneous coronary intervention (PCI) represent a complex population and are at higher risk of early readmission. The reasons and predictors of early readmission in this group have not been well characterized. We identified patients in an integrated health care system who underwent PCI between 2009 and 2014 and were readmitted within 30 days within this health care system. Of the 9,357 patients surviving to discharge after the index PCI, 692 were readmitted within 30 days (7.4%). At the time of readmission, 143 had been discharged from the index PCI hospitalization on OACs (96.5% on warfarin) and 549 had not been discharged on OACs, with readmission rates of 12.9% and 6.7%, respectively (p<0.01). The most common reason for readmission among all patients was chest pain syndromes (21.7% on OACs, 34.4% not on OACs). However, bleeding represented the next most frequent cause of readmission among patients on OACs (14.0% on OACs vs 6.0% not on OACs, p<0.01). Among patients on OAC therapy, peripheral arterial disease (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.07–2.57, p = 0.02) and nonelective PCI (OR 1.91, 95% CI 1.17–3.12, p<0.01) were found to be independent predictors of 30-day readmission. During rehospitalization, compared to patients not on OACs, patients on OACs suffered a higher unadjusted rate of mortality (6.3% vs 1.8%, p<0.01) and a longer length of stay (6.4 ± 7.1 days vs 4.9 ± 6.8 days, p = 0.02). In conclusion, patients discharged on OAC therapy after PCI are commonly readmitted, with bleeding representing a major reason. These readmissions are associated with high mortality and longer lengths of stay. Interventions targeted towards optimizing discharge planning for these complex patients are needed to potentially reduce readmissions.
Highlights
Readmissions following percutaneous coronary intervention (PCI) are expensive and burdensome for patients
Clinical characteristics of patients discharged on oral anticoagulant (OAC) therapy after index PCI
Patients discharged on OACs presented more often with ST-elevation myocardial infarction (STEMI), experienced higher rates of cardiogenic shock within 24 hours of PCI, and underwent higher rates of emergent PCI
Summary
Readmissions following percutaneous coronary intervention (PCI) are expensive and burdensome for patients. The Centers for Medicare & Medicaid Services (CMS) Hospital Readmissions Reduction Program penalizes hospitals for higher than expected 30-day readmission rates for certain medical conditions, including acute myocardial infarction (MI) and heart failure [3]. Since many of these patients undergo PCI during their hospitalization, reducing readmissions after PCI has become a priority for hospital systems, and interventions targeted towards reducing readmissions post-PCI have been implemented [2,4]. The CMS recently announced a new voluntary bundled payment model, the Bundled Payments for Care Improvement Advanced, which ties reimbursement for PCI to several quality measures including readmission [5]
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