Readmission Rates following Percutaneous Coronary Intervention

The Centers for Medicare & Medicaid Services publicly reports hospital-level, 30-day, risk-standardized readmission rates for patients hospitalized for congestive heart failure (CHF), acute myocardial infarction, and for patients undergoing percutaneous coronary intervention (PCI). A provision of the Patient Protection and Affordable Care Act will link quality outcomes, including 30-day readmission rates, to hospital reimbursement. A recent analysis of Medicare beneficiaries who underwent PCI in 2005 found that readmission and mortality rates were 14.6% and 1.0%, respectively. Readmitted patients have a greater risk of 30-day mortality. However, Medicare beneficiaries account for only 49% of all PCIs. Thus, researchers recently noted that there is limited awareness of demographic, clinical, and procedural factors associated with 30-day readmission after PCI for a general population. Also, the association between 30-day readmission after PCI and 1-year mortality is also not well documented. The Mayo Clinic in Rochester, Minnesota, prospectively collects demographic, clinical, and procedural variables, as well as follow-up outcomes, including readmission and mortality, for all patients undergoing PCI. Researchers recently conducted a prospective analysis to identify factors associated with 30-day readmission rates, the reason for the readmission, and the association of 30-day readmission with 1-year mortality for patients following PCI. They reported study results online in Archives of Internal Medicine [doi:10.1001/archinternmed.2011.569]. The researchers identified 15,498 hospitalizations (elective or for acute coronary syndromes) from January 1998 through June 2008 at Saint Marys Hospital, Rochester, Minnesota. Of those, 9.4% (n=1459) were readmitted within 30 days. There were 106 deaths within 30 days (0.68%), including 33 deaths that occurred during or after a readmission and 73 deaths that were not associated with a readmission. Following multivariate analysis, demographic factors associated with an increased risk of 30-day readmission after PCI were female sex (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.17-1.48), Medicare insurance (OR, 1.20; 95% CI, 1.01-1.43, compared with all other insurance), and less than a high school education (OR, 1.35; 95% CI, 1.17-1.55, compared with high school graduate or higher education levels). Clinical and procedural factors associated with an increased risk of readmission included CHF at presentation (OR, 1.36; 95% CI, 1.15-1.60), cerebrovascular accident/transient ischemic attack (OR, 1.22; 95% CI, 1.04-1.44), moderate-to-severe renal disease (OR, 1.46; 95% CI, 1.12-1.89), chronic obstructive pulmonary disease (OR, 1.31; 95% CI, 1.12-1.54), peptic ulcer disease (OR, 1.29; 95% CI, 1.05-1.59), metastatic cancer (OR, 1.92; 95% CI, 1.19-3.09), and a length of stay of >3 days (OR, 1.59; 95% CI, 1.37-1.84). Of the PCI patients readmitted within 30 days, 69% (n=1003) were readmitted for cardiac-related reasons. Repeated PCI was performed on 61 patients within 30 days of discharge. In adjusted analysis, 30-day readmission rates after PCI were associated with a higher risk of 1-year mortality (hazard ratio [HR], 1.99; 95% CI, 1.57-2.52; P<.001).