Etiologies and predictors of 30‐day readmissions in patients undergoing percutaneous mechanical circulatory support–assisted percutaneous coronary intervention in the United States: Insights from the Nationwide Readmissions Database

Abstract

Background Patients undergoing percutaneous mechanical circulatory support (pMCS)‐assisted percutaneous coronary intervention (PCI) represent a high‐risk group vulnerable to complications and readmissions. Hypothesis Thirty‐day readmissions after pMCS‐assisted PCI are common among patients with comorbidities and account for a significant amount of healthcare spending. Methods Patients undergoing PCI and pMCS (Impella, TandemHeart, or intra‐aortic balloon pump) for any indication between January 1, 2012, and November 30, 2014, were selected from the Nationwide Readmissions Database. Patients were identified using appropriate ICD‐9‐CM codes. Clinical risk factors and complications were analyzed for association with 30‐day readmission. Results Our analysis included 29 247 patients, of which 4535 (15.5%) were readmitted within 30 days. On multivariate analysis, age ≥ 65 years, female sex, hypertension, diabetes, chronic lung disease, heart failure, prior implantable cardioverter‐defibrillator, liver disease, end‐stage renal disease, and length of stay ≥5 days during index hospitalization were independent predictors of 30‐day readmission. Cardiac etiologies accounted for ~60% of readmissions, of which systolic or diastolic heart failure (22%), stable coronary artery disease (11.1%), acute coronary syndromes (8.9%), and nonspecific chest pain (4.0%) were the most common causes. In noncardiac causes, sepsis/septic shock (4.6%), hypotension/syncope (3.2%), gastrointestinal bleed (3.1%), and acute kidney injury (2.6%) were among the most common causes of 30‐day readmissions. Mean length of stay and cost of readmissions was 4 days and $16 191, respectively. Conclusions Thirty‐day readmissions after pMCS‐assisted PCI are common and are predominantly associated with increased burden of comorbidities. Reducing readmissions for common cardiac etiologies could save substantial healthcare costs.

Relationship between dynamic changes of peri-procedure anxiety and short-term prognosis in patients undergoing elective percutaneous coronary intervention for coronary heart disease: A single-center, prospective study

“…Readmissions due to hypertension accounted for 48.15% of total readmissions. This may be due to the fact that the implementation time of this study was in winter, and the cold weather resulted in blood pressure of patients increased, while the blood pressure of the elderly fluctuated greatly, leading to a higher readmission rate [40]. Half of the patients in this study had hypertension, and as shown in Table 8, more than one-third of the patients were admitted to hospital for exacerbation of hypertension, confirming our conclusion.…”

Thirty-day readmission after endovascular or surgical revascularization for chronic mesenteric ischemia: Insights from the Nationwide Readmissions Database

“…Previous analyses have observed that female sex and older age are associated with readmission after other cardiovascular procedures. 9–11 Although we previously demonstrated in a large nationwide analysis that endovascular revascularization was associated with fewer index hospital complications (including MACCE), lower costs, and shorter lengths of stay compared with surgery, 3 there was no independent association between revascularization strategy and likelihood of readmission.…”

Mechanical Circulatory Support in Women

“…Women are more prone to develop vascular complications with Impella devices, likely due to smaller common femoral arterial size [21]. Female gender significantly predicted 30-day readmissions in patients undergoing percutaneous VAD (pVAD)-assisted PCI in the Nationwide Readmissions Database, one reason for which could be vascular complications [22].…”