Women Have Higher Risk of Unplanned Readmission After PCI

Approximately one in 10 individuals who undergo PCI in the United States end up back in the hospital within 30 days, with women more likely than men to be readmitted within this first month, according to the results of a new study.

The reasons for the unplanned readmission after PCI are largely for noncardiac causes. But when the cause for readmission is cardiac, men are more likely to be readmitted for coronary artery disease, including angina, and women for heart failure, report investigators.

“It’s a hot topic at the moment, because we don’t know a lot about readmissions,” said lead investigator Chun Shing Kwok, MD (Keele Cardiovascular Research Group, Stoke-on-Trent, England). “Sometimes patients come back for cardiology-related problems, but sometimes they come in for other non-cardiology-related things and clinicians aren’t always aware of the readmissions. The patient might go to emergency services and end up in a different specialty.”

For this reason, Kwok said that while cardiologists can control numerous factors during and after the procedure, such as stent selection and choice of antithrombotic agents, targeted interventions are still needed to reduce readmissions after PCI, particularly for noncardiac causes and particularly in women.

The results of the study were published online January 10, 2018, in the American Journal of Cardiology.

Different Risks for Men and Women

Hospital readmissions are frequently used as a metric of healthcare quality and efficiency. The researchers point out that readmission rates can act as a surrogate for quality of care during the index hospitalization and several healthcare systems have implemented financial incentives for avoiding readmissions within 30 days of discharge. In the US, for example, the Affordable Care Act authorized the Centers for Medicare & Medicaid Services to reduce payments to hospitals with excessive readmissions compared with the national average. 

Using 2013-2014 data from the Nationwide Readmissions Database produced by the Agency for Healthcare Research and Quality, Kwok and colleagues sought to analyze differences between men and women with respect to readmission following PCI. In total, they studied 832,753 men and women who survived the index PCI and had an unplanned hospital readmission within 30 days.

Overall, 11.5% of women were readmitted to hospital within 30 days compared with 8.4% of men (P < 0.001). The women on average were older than men (67.5 years vs 63.5 years; P < 0.001) and had more comorbidities. For example, women were more likely to have diabetes, obesity, chronic lung disease, hypothyroidism, anemia, and depression. After adjusting for the differences in clinical and procedural characteristics between the sexes, however, women were still more likely to be readmitted to hospital within 30 days (OR 1.19; 95% CI 1.16-1.22).

To TCTMD, Kwok pointed out that while they attempted to adjust for confounding variables, the study is observational in nature and subject to the limitations of retrospective analyses. Still, the large database suggests that risks for readmission, including the reasons for the unplanned return to hospital, differ between men and women.

Among men, 55% were readmitted for noncardiac causes, such as nonspecific chest pain, infections, and gastrointestinal issues. Among women, 58% were readmitted for noncardiac causes. For those admitted due to cardiac causes, coronary artery disease (33.5%), acute MI (22.5%), and heart failure (22.3%) were the leading three causes among men. For women, the leading three cardiac causes of readmission were heart failure (29.6%), coronary artery disease (28.5%), and acute MI (20.0%).

Targeted interventions to reduce readmission, including a greater focus on reducing the risk of heart failure in women, are needed, according to Kwok. 

“There’s all kinds of different strategies we can use, such as educating the patient about symptoms and when to seek help,” said Kwok. “There are other things like early follow-up. And if we’re going to target noncardiac complications, perhaps they need referrals to other specialties. Additionally, we can educate the physicians about noncardiac problems that might need to be managed prior to discharge.”