Readmissions to Hospital After Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis of Factors Associated with Readmissions

Kwok, Chun Shing; Narain, Aditya; Pacha, Homam Moussa; Lo, Ted S.; Holroyd, Eric W.; Alraies, M. Chadi; Nolan, Jim; Mamas, Mamas A.

Abstract

Background
Readmissions after PCI are a burden to patients and health services that are not well understood.

Methods
A systematic review was performed to identify studies of readmission after PCI. Readmission rates and causes of readmission were examined and factors associated with 30-day readmissions were combined using meta-analyses.

Results
A total of 39 studies evaluated readmissions after PCI (6,569,690 patients, 31 studies). The 30-day readmission rate varied from 3.3%–15.8%. Beyond 30-days, the readmission rate was 6% at 2 months, 31.5% at 6 months, 18.6–50.4% at 12 months and 26.3–71% beyond 48 months. The pooled proportion of patients with cardiac cause for readmissions ranged from 4.6%–75.3%. The range of rates of 30-day readmissions for reinfarction/stent thrombosis, heart failure, chest pain and bleeding were 2.5%–9.5%, 5.9%–12%, 6.7–38.1% and 0.7–7.5%, respectively. Meta-analysis suggests that female gender (RR 1.25(1.20–1.30), I2 = 65.2%), diabetes (RR 1.22(1.20–1.25), I2 = 0%), heart failure (RR 1.43(CI 1.28–1.60), I2 = 92.8%), renal failure (RR 1.50(1.45–1.55), I2 = 0%), chronic lung disease (RR 1.34(1.26–1.44), I2 = 87.5%), peripheral artery disease (RR 1.20(1.15–1.25), I2 = 46.5%) and cancer (RR 1.35(1.15–1.58), I2 = 72.8%) were associated with 30-day readmissions. The average cost of unplanned and all 30-day readmissions has been reported to be $12,636 and $17,576, respectively.

Conclusions
We estimate that 1 in 7 patients who undergo PCI are readmitted within 30-days and the rate can rise to up to 3 in 4 patients beyond 3 years. Interventions should be considered to reduce readmissions such as discharge checklists, evaluation of medication compliance at follow-up and prompt management when patients re-present to emergency department.

Citation

Kwok, C. S., Narain, A., Pacha, H. M., Lo, T. S., Holroyd, E. W., Alraies, M. C., Nolan, J., & Mamas, M. A. (2020). Readmissions to Hospital After Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis of Factors Associated with Readmissions. Cardiovascular Revascularization Medicine, 21(3), 375-391. https://doi.org/10.1016/j.carrev.2019.05.016

• Journal Article Type: Article
• Acceptance Date: May 17, 2019
• Online Publication Date: May 27, 2019
• Publication Date: 2020-03
• Deposit Date: Jun 27, 2023
• Journal: CARDIOVASCULAR REVASCULARIZATION MEDICINE
• Print ISSN: 1553-8389
• Electronic ISSN: 1878-0938
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 21
• Issue: 3
• Pages: 375-391
• DOI: https://doi.org/10.1016/j.carrev.2019.05.016
• Public URL: https://keele-repository.worktribe.com/output/508137