Bavishi C, et al. - Researchers tested the premise that, among patients with comorbidities, 30-day readmissions after percutaneous mechanical circulatory support (pMCS)-assisted percutaneous coronary intervention (PCI) are common and account for a significant amount of healthcare spending. They noted that of patients who underwent PCI and pMCS for any indication, 15.5% were readmitted within 30-days after the procedure. These readmissions were found to be mainly related to increased burden of comorbidities. Substantial healthcare costs could be saved by attenuating readmissions for common cardiac etiologies.

Methods

• Using the Nationwide Readmissions Database, researchers selected patients undergoing PCI and pMCS (Impella, TandemHeart, or intra-aortic balloon pump) for any indication between January 1, 2012, and November 30, 2014.
• They assessed if clinical risk factors and complications were associated with 30-day readmission.

Results

• Ultimately, 4,535 (15.5%) out of a total of 29,247 included patients sought readmission within 30-days.
• Multivariate analysis revealed the following independent predictors of 30-day readmission: 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.
• Cardiac etiologies were found to be responsible for ~60% of readmissions, the most common causes were systolic or diastolic heart failure (22%), stable coronary artery disease (11.1%), acute coronary syndromes (8.9%), and nonspecific chest pain (4.0%).
• The most common noncardiac causes of 30-day readmissions were sepsis/septic shock (4.6%), hypotension/syncope (3.2%), gastrointestinal bleed (3.1%), and acute kidney injury (2.6%).
• Data showed that mean length of stay was 4 days, and cost of readmissions was $16,191.