Abstract
Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines exist for many medications commonly prescribed prior to hospital discharge, yet there are limited data regarding the contribution of gene-x-drug interactions to hospital readmissions. The present study evaluated the relationship between prescription of CPIC medications prescribed within 30 days of hospital admission and 90-day hospital readmission from 2010 to 2020 in a study population (N = 10,104) who underwent sequencing with a 14-gene pharmacogenetic panel. The presence of at least one pharmacogenetic indicator for a medication prescribed within 30 days of hospital admission was considered a gene-x-drug interaction. Multivariable logistic regression analyzed the association between one or more gene-x-drug interactions with 90-day readmission. There were 2211/2354 (93.9%) admitted patients who were prescribed at least one CPIC medication. Univariate analyses indicated that the presence of at least one identified gene-x-drug interaction increased the risk of 90-day readmission by more than 40% (OR = 1.42, 95% confidence interval (CI) 1.09–1.84) (p = 0.01). A multivariable model adjusting for age, race, sex, employment status, body mass index, and medical conditions slightly attenuated the effect (OR = 1.32, 95% CI 1.02–1.73) (p = 0.04). Our results suggest that the presence of one or more CPIC gene-x-drug interactions increases the risk of 90-day hospital readmission, even after adjustment for demographic and clinical risk factors.
Highlights
White/non-Hispanic (p = 0.0002), more likely to be married (p < 0.0001), less likely to be employed (p < 0.0001), and were more likely to have a history of a major medical condition including asthma, cancer, Chronic obstructive pulmonary disease (COPD), CVD, diabetes, HF, hypertension, MI, or Peripheral vascular disease (PVD) (p < 0.0001)
Compared to patients with 10-year histories of at least one hospital admission who were not readmitted to hospital, patients with a history of 90-day hospital readmissions were older (p < 0.0001), and readmitted patients were more likely to have a history of a major medical condition
Admission dates from electronic health record 1 December 2009 and 31 December 2020 inclusive. This is the first published study to report the net effect of a panel of pharmacogenetic variants on hospital readmission in a large, primary-care-based patient population
Summary
Despite a major national program to reduce hospital readmissions, 30-day hospital readmission rates for acute myocardial infarction, heart failure, and pneumonia are more than 17% [1], representing a major quality gap [2]. 21% of hospital readmissions were due to adverse drug reactions [3]. Several large-scale pharmacogenetic implementation consortia have evaluated medical outcomes, but few have reported associations between a composite panel of gene-x-drug interactions and all prescribed medications that have evidence-based guidance from the Clinical Pharmacogenomics Implementation Consortium (CPIC) [4]. Studies from the Mayo Clinic Biobank have reported mixed results regarding associations between pharmacogenetic (PGx) phenotypes and hospital admissions [5,6], but these analyses did not evaluate gene-x-drug interactions.
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