Abstract 310: 30-day Readmission Following PCI Predicts Worse Long-term Patient Outcomes: Insights from the VA CART Program
Background: 30-day readmission after percutaneous coronary intervention (PCI) is a common, expensive and potentially preventable problem. The relationship between 30-day readmission and long-term patient outcomes has not been studied within integrated care delivery settings. We sought to determine the association between 30-day readmission after PCI and long-term patient outcomes in the VA.
Methods: We evaluated all VA patients who underwent PCI from October 2007 through September 2011 using national data from the VA Clinical Assessment Reporting and Tracking (CART) Program. Patient outcomes were followed through September 2012. Our primary outcome was all-cause mortality. Secondary outcomes included myocardial infarction (MI), revascularization, and the composite of all three outcomes. We compared patient demographics, clinical characteristics, and procedural factors by 30-day readmission status. The association between 30-day readmission status and outcomes was assessed using Cox proportional hazards models.
Results: Among 32,551 patients undergoing PCI, 4,829 (14.8%) were readmitted within 30 days. Median follow-up after discharge was 30.3 months (IQR: 19.5, 43.6). Over this period of follow-up, a total of 4,548 (14%) died, 2,021 (6.2%) suffered an MI, and 7,040 (21.6%) underwent revascularization. Patients with subsequent readmission were more likely to have chronic kidney disease (26% vs 18%, P<.01) or chronic obstructive pulmonary disease (32% vs 23%, P<.01) and more likely to be presenting with an acute coronary syndrome (60% vs 48%, P<0.01) during the index hospitalization. Thirty-day readmission was associated with worse risk-adjusted outcomes (Table 1).
Conclusions: In the VA, approximately 15% of patients were readmitted within 30 days of PCI - a rate that is comparable to prior studies from community settings. Patients readmitted within 30-days had significantly higher long-term mortality risks. Future research should aim to understand modifiable causes of readmission and the extent to which 30-day readmission is a quality metric rather than a risk marker.
Author Disclosures: T.W. Hegeman: None. T.J. Glorioso: None. A.E. Baron: None. P.M. Schneider: None. R.E. Burke: None. P. Ho: None. J.S. Rumsfeld: None. T.M. Maddox: None. P.A. Heidenreich: None. K. Mavromatis: None. A.A. Bavry: None. S.M. Bradley: None.
- © 2014 by American Heart Association, Inc.