Abstract 350: The ‘Frequent Flyer’ Hypothesis and Increased Risk of Thirty Day Readmission after Percutaneous Coronary Intervention
Background: Thirty day readmission (30DR) post PCI is both prevalent and significant. These readmissions are associated with increased costs of care. Previous studies have shown comorbidities, socio-demographics, and angiographic characteristics as risk factors for readmission post PCI. However, unique factors such as prior frequent admissions and specifically its interaction with anxiety or depression as risk factors for readmission after PCI have not been studied.
Methods: We retrospectively analyzed 1,343 consecutive PCIs representing 1,256 patients from a single institution from February 1, 2012 to August 13, 2013. The primary outcome was 30DR post PCI. Secondary outcomes included 30DR for PCI, CABG, and acute systolic or diastolic heart failure. The independent variables were ‘number of prior admissions in the 12 months before PCI’ and history of ‘anxiety or depression’ based on an ICD9 diagnosis in the preceding 10 years. Negative binominal and logistic regression models were built to examine the association between ‘anxiety or depression’ diagnosis, number of prior admissions, and 30DR after adjusting for known covariates including: age, gender, admission status, prior CABG, CHF, chronic lung disease, peripheral artery disease, cardiogenic shock, renal function, and insurance.
Results: Of the 1,343 PCIs, 30.6% were readmitted within 30 days. We observed a large prevalence of ‘anxiety or depression’ in patients undergoing PCI (439, 33%). The mean number of 30DR post PCI was higher at 0.55 for patients with anxiety or depression and 0.43 for patients without anxiety or depression (P=0.006). Prior admissions were a strong and independent risk factor for 30DR with OR 1.258 (95% CI 1.164 to 1.360, P<0.001). ‘Anxiety or depression’ was also an independent risk factor for 30DR with OR 1.384 (95% CI 1.056 to 1.814, P=0.019). Interestingly, patients with anxiety or depression did not have significantly different 30DR for PCI, CABG, acute systolic or diastolic CHF 0.093 (95% CI 0.068 to 0.128) vs. 0.087 (95% CI 0.070, 0.109) among patients without anxiety or depression (p=0.74).
Conclusion: A prior history of frequent admissions and anxiety or depression diagnoses contribute significantly and independently towards 30DR post PCI, even after adjusting for traditional risk factors of readmissions. As such, they should be considered as important risk factors for post PCI readmission. Patients with diagnoses of anxiety or depression were not at increased risk of 30DR for cardiovascular events such as PCI, CABG or acute CHF. Future studies are needed to evaluate the role of treating anxiety and depression in patients at risk for frequent readmissions.
Author Disclosures: A.J. Carlisle: None. A. Tibrewala: None. E. Novak: None. J. Singh: None. A.P. Amin: None.
- © 2014 by American Heart Association, Inc.