Addressing 30-day readmissions of PCI patients may not improve mortality rates

While 30-day readmission rates for percutaneous coronary interventions have been considered as a potential quality measure, there is a lack of correlation between 30-day PCI readmission and mortality risk at the hospital level, according to a new study published in the Journal of the American Heart Association.

PCIs are non-surgical procedures that use a catheter to implant a stent, which makes room for blood vessels that have been constricted by plaque buildup. The rates of 30-day readmissions among this patient group are relatively high and associated with an increased likelihood of death within the first year. But at the hospital level, the relationship between PCI readmissions and mortality is less clear.

For the study, researchers examined data on more than 41,000 PCI patients from The VA Clinical Assessment, Reporting and Tracking program collected from October 2007 to August 2012.

Overall, 12.2 percent of patients needed to be readmitted within 30 days of their procedure, although that rate ranged from 6.6 percent to 19.4 percent depending on the center. Readmitted patients displayed an increased risk of mortality within one year after adjusting for potential contributing factors. However, when the readmission rates and mortality rates were adjusted at the hospital level, no significant correlation between the two numbers could be established.

"Strategies to reduce readmissions after PCI and to improve outcomes in this high‐risk patient population are greatly needed. With a nearly 50 percent increase in risk of mortality after controlling for the patient‐risk factors, patients readmitted after PCI require careful consideration to discover the impact of nontraditional risk factors," wrote the authors. "It is unlikely that incentivizing hospitals to avoid post‐PCI readmissions will impact the increased mortality of this high‐risk group ... Efforts directed at reducing readmissions may improve patient satisfaction and cost while separate efforts directed at understanding the underlying association between readmission and mortality may someday lead to improved survival in this high‐risk group."

The authors acknowledged their findings were limited since the patient population of their study was 98 percent male.

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