Predictors and etiologies of 30-day readmissions in patients with non-ST-elevation acute coronary syndrome

Alejandro Lemor, Gabriel A. Hernandez, Nish Patel, Vanessa Blumer, Karan Sud, Mauricio G Cohen, Eduardo De Marchena, Annapoorna S. Kini, Samin K. Sharma, Carlos E Alfonso

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Despite improvements in acute care and survival after non-ST-elevation acute coronary syndrome (NSTE-ACS) hospitalization, early readmissions remain common, and have significant clinical and financial impact. Objectives: Determine the predictors and etiologies of 30-day readmissions in NSTE-ACS. Method: The study cohort was derived from the National Readmission Database 2014 identifying patients with a primary diagnosis of NSTE-ACS using ICD9 code. Results: We identified a total of 300,269 patients admitted with NSTE-ACS; 13.4% were readmitted within 30-day. The most common cause of readmission was heart failure (HF) (15.6%), followed by a recurrent myocardial infarction (MI) (10%). Predictors of increased readmissions were age ≥ 75 years (OR: 1.34, 95% CI: 1.30–1.39), female gender (OR 1.12, 95% CI 1.09–1.16), a Charlson Comorbidity Index (CCI) >3 (OR 2.11, 95% CI: 2.04–2.18), ESRD (OR 2.01, 95% CI 1.89–2.14), CKD (OR: 1.58, 95% CI: 1.51–1.64), length of stay ≥5 days (OR: 1.51, 95% CI 1.46–1.56) and adverse events during the index admission such as AKI (OR:1.31, 95% CI: 1.25–1.36), major bleeding (OR:1.20, 95% CI: 1.12–1.24); whereas admission to a teaching hospital (OR 0.92, 95% CI 0.89–0.95) and PCI (OR 0.70, 95% CI 0.67–0.72) were associated with less likelihood of 30-day readmission. Conclusion: Readmission rate at 30-days is high among NSTE-ACS patients and the most common readmission etiologies are HF and recurrent MI. A CCI more than 3 and ESRD were the most significant predictors for readmission; patients undergoing PCI had less odds of readmission.

Original languageEnglish (US)
JournalCatheterization and Cardiovascular Interventions
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Patient Readmission
Acute Coronary Syndrome
Chronic Kidney Failure
Comorbidity
Heart Failure
Myocardial Infarction
Teaching Hospitals
Length of Stay
Hospitalization
Cohort Studies
Databases
Hemorrhage
Survival

Keywords

  • Myocardial infarction
  • NSTE-ACS
  • readmission

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Predictors and etiologies of 30-day readmissions in patients with non-ST-elevation acute coronary syndrome. / Lemor, Alejandro; Hernandez, Gabriel A.; Patel, Nish; Blumer, Vanessa; Sud, Karan; Cohen, Mauricio G; De Marchena, Eduardo; Kini, Annapoorna S.; Sharma, Samin K.; Alfonso, Carlos E.

In: Catheterization and Cardiovascular Interventions, 01.01.2018.

Research output: Contribution to journalArticle

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title = "Predictors and etiologies of 30-day readmissions in patients with non-ST-elevation acute coronary syndrome",
abstract = "Background: Despite improvements in acute care and survival after non-ST-elevation acute coronary syndrome (NSTE-ACS) hospitalization, early readmissions remain common, and have significant clinical and financial impact. Objectives: Determine the predictors and etiologies of 30-day readmissions in NSTE-ACS. Method: The study cohort was derived from the National Readmission Database 2014 identifying patients with a primary diagnosis of NSTE-ACS using ICD9 code. Results: We identified a total of 300,269 patients admitted with NSTE-ACS; 13.4{\%} were readmitted within 30-day. The most common cause of readmission was heart failure (HF) (15.6{\%}), followed by a recurrent myocardial infarction (MI) (10{\%}). Predictors of increased readmissions were age ≥ 75 years (OR: 1.34, 95{\%} CI: 1.30–1.39), female gender (OR 1.12, 95{\%} CI 1.09–1.16), a Charlson Comorbidity Index (CCI) >3 (OR 2.11, 95{\%} CI: 2.04–2.18), ESRD (OR 2.01, 95{\%} CI 1.89–2.14), CKD (OR: 1.58, 95{\%} CI: 1.51–1.64), length of stay ≥5 days (OR: 1.51, 95{\%} CI 1.46–1.56) and adverse events during the index admission such as AKI (OR:1.31, 95{\%} CI: 1.25–1.36), major bleeding (OR:1.20, 95{\%} CI: 1.12–1.24); whereas admission to a teaching hospital (OR 0.92, 95{\%} CI 0.89–0.95) and PCI (OR 0.70, 95{\%} CI 0.67–0.72) were associated with less likelihood of 30-day readmission. Conclusion: Readmission rate at 30-days is high among NSTE-ACS patients and the most common readmission etiologies are HF and recurrent MI. A CCI more than 3 and ESRD were the most significant predictors for readmission; patients undergoing PCI had less odds of readmission.",
keywords = "Myocardial infarction, NSTE-ACS, readmission",
author = "Alejandro Lemor and Hernandez, {Gabriel A.} and Nish Patel and Vanessa Blumer and Karan Sud and Cohen, {Mauricio G} and {De Marchena}, Eduardo and Kini, {Annapoorna S.} and Sharma, {Samin K.} and Alfonso, {Carlos E}",
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T1 - Predictors and etiologies of 30-day readmissions in patients with non-ST-elevation acute coronary syndrome

AU - Lemor, Alejandro

AU - Hernandez, Gabriel A.

AU - Patel, Nish

AU - Blumer, Vanessa

AU - Sud, Karan

AU - Cohen, Mauricio G

AU - De Marchena, Eduardo

AU - Kini, Annapoorna S.

AU - Sharma, Samin K.

AU - Alfonso, Carlos E

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Despite improvements in acute care and survival after non-ST-elevation acute coronary syndrome (NSTE-ACS) hospitalization, early readmissions remain common, and have significant clinical and financial impact. Objectives: Determine the predictors and etiologies of 30-day readmissions in NSTE-ACS. Method: The study cohort was derived from the National Readmission Database 2014 identifying patients with a primary diagnosis of NSTE-ACS using ICD9 code. Results: We identified a total of 300,269 patients admitted with NSTE-ACS; 13.4% were readmitted within 30-day. The most common cause of readmission was heart failure (HF) (15.6%), followed by a recurrent myocardial infarction (MI) (10%). Predictors of increased readmissions were age ≥ 75 years (OR: 1.34, 95% CI: 1.30–1.39), female gender (OR 1.12, 95% CI 1.09–1.16), a Charlson Comorbidity Index (CCI) >3 (OR 2.11, 95% CI: 2.04–2.18), ESRD (OR 2.01, 95% CI 1.89–2.14), CKD (OR: 1.58, 95% CI: 1.51–1.64), length of stay ≥5 days (OR: 1.51, 95% CI 1.46–1.56) and adverse events during the index admission such as AKI (OR:1.31, 95% CI: 1.25–1.36), major bleeding (OR:1.20, 95% CI: 1.12–1.24); whereas admission to a teaching hospital (OR 0.92, 95% CI 0.89–0.95) and PCI (OR 0.70, 95% CI 0.67–0.72) were associated with less likelihood of 30-day readmission. Conclusion: Readmission rate at 30-days is high among NSTE-ACS patients and the most common readmission etiologies are HF and recurrent MI. A CCI more than 3 and ESRD were the most significant predictors for readmission; patients undergoing PCI had less odds of readmission.

AB - Background: Despite improvements in acute care and survival after non-ST-elevation acute coronary syndrome (NSTE-ACS) hospitalization, early readmissions remain common, and have significant clinical and financial impact. Objectives: Determine the predictors and etiologies of 30-day readmissions in NSTE-ACS. Method: The study cohort was derived from the National Readmission Database 2014 identifying patients with a primary diagnosis of NSTE-ACS using ICD9 code. Results: We identified a total of 300,269 patients admitted with NSTE-ACS; 13.4% were readmitted within 30-day. The most common cause of readmission was heart failure (HF) (15.6%), followed by a recurrent myocardial infarction (MI) (10%). Predictors of increased readmissions were age ≥ 75 years (OR: 1.34, 95% CI: 1.30–1.39), female gender (OR 1.12, 95% CI 1.09–1.16), a Charlson Comorbidity Index (CCI) >3 (OR 2.11, 95% CI: 2.04–2.18), ESRD (OR 2.01, 95% CI 1.89–2.14), CKD (OR: 1.58, 95% CI: 1.51–1.64), length of stay ≥5 days (OR: 1.51, 95% CI 1.46–1.56) and adverse events during the index admission such as AKI (OR:1.31, 95% CI: 1.25–1.36), major bleeding (OR:1.20, 95% CI: 1.12–1.24); whereas admission to a teaching hospital (OR 0.92, 95% CI 0.89–0.95) and PCI (OR 0.70, 95% CI 0.67–0.72) were associated with less likelihood of 30-day readmission. Conclusion: Readmission rate at 30-days is high among NSTE-ACS patients and the most common readmission etiologies are HF and recurrent MI. A CCI more than 3 and ESRD were the most significant predictors for readmission; patients undergoing PCI had less odds of readmission.

KW - Myocardial infarction

KW - NSTE-ACS

KW - readmission

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