Readmission after inpatient percutaneous coronary intervention in the Medicare population from 2000 to 2012.

ABSTRACT

BACKGROUND: Since year 2000, reducing hospital readmissions has become a public health priority. In addition, there have been major changes in percutaneous coronary intervention (PCI) during this period. METHODS: The cohort consisted of 3,250,194 patients admitted for PCI from January 2000 through November 2012. RESULTS: Overall, 30-day readmission was 15.8%. Readmission rates declined from 16.1% in 2000 to 15.4% in 2012 (adjusted odds ratio for readmission 1.33 in 2000 compared with 2012). Of all readmissions after PCI, the majority were for cardiovascular-related conditions (>60%); however, only a small percentage (<8%) of total readmissions were for acute myocardial infarction, unstable angina, or cardiac arrest/cardiogenic shock. A much larger percentage of patients were readmitted with chest pain/angina (7.9%), chronic ischemic heart disease (26.6%), and heart failure (12%). A small proportion was due to procedural complications and gastrointestinal (GI) bleeding. The use of PCI with stenting during readmissions was variable, increasing from 14.2% in 2000 to 23.7% in 2006 and then declining to 12.1% in 2012. Hospital mortality during readmission was 2.5% overall and varied over time (2.8% in 2000, decreasing to 2.2% in 2006 and then rising again to 3.1% in 2012). Patients who were readmitted had >4× higher 30-day mortality than those who were not. CONCLUSIONS: Among Medicare beneficiaries, readmission after PCI declined over time despite patients having more comorbidities. This translated into a 33% lower likelihood of readmission in 2012 compared with 2000. A small proportion of readmissions were for acute coronary syndromes.