1. Predictors and etiologies of 30-day readmissions in patients with non-ST-elevation acute coronary syndrome.
- Author
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Lemor A, Hernandez GA, Patel N, Blumer V, Sud K, Cohen MG, De Marchena E, Kini AS, Sharma SK, and Alfonso CE
- Subjects
- Acute Coronary Syndrome diagnosis, Acute Coronary Syndrome epidemiology, Adolescent, Adult, Aged, Cardiovascular Agents adverse effects, Comorbidity, Databases, Factual, Female, Heart Failure diagnosis, Heart Failure epidemiology, Humans, Kidney Failure, Chronic epidemiology, Male, Middle Aged, Non-ST Elevated Myocardial Infarction diagnosis, Non-ST Elevated Myocardial Infarction epidemiology, Recurrence, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, United States epidemiology, Young Adult, Acute Coronary Syndrome therapy, Cardiovascular Agents therapeutic use, Coronary Artery Bypass, Heart Failure therapy, Non-ST Elevated Myocardial Infarction therapy, Patient Readmission, Percutaneous Coronary Intervention adverse effects
- 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., (© 2018 Wiley Periodicals, Inc.)
- Published
- 2019
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