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Relation Between Age and Unplanned Readmissions After Percutaneous Coronary Intervention (Findings from the
Chun Shing Kwok1, Sunil V Rao2, Ian Gilchrist3
1Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.
Insights
Older patients face higher unplanned readmission rates after percutaneous coronary intervention (PCI). Age-specific interventions are crucial for reducing these readmissions, which are often due to non-cardiac causes like infections and bleeding.
Area of Science:
- Cardiology
- Geriatrics
- Health Services Research
Background:
- Unplanned early readmissions after percutaneous coronary intervention (PCI) pose a significant challenge.
- The impact of patient age on readmission rates and their underlying causes following PCI remains incompletely understood.
Purpose of the Study:
- To investigate the relationship between patient age and the rates and causes of 30-day unplanned readmissions after PCI.
- To identify age-specific patterns in readmission etiology to inform targeted interventions.
Main Methods:
- Analysis of a large national dataset (Nationwide Readmission Database) from 2010-2014 in the United States.
- Examination of over 2.2 million PCI procedures, stratifying outcomes by age groups: <55, 55-64.9, 65-74.9, and ≥75 years.
- Comparison of age-specific 30-day unplanned readmission rates and detailed analysis of readmission causes.
Main Results:
- The overall unplanned 30-day readmission rate was 9.6%, increasing with age (8.1% for <55 years to 12.6% for ≥75 years).
- Non-cardiac causes, particularly infections, gastrointestinal disease, and bleeding, were more prevalent in older patients (≥75 years) compared to younger cohorts.
- Older patients showed higher rates of heart failure readmissions but lower rates of coronary artery disease-related readmissions (e.g., angina) compared to younger patients.
Conclusions:
- Older individuals experience the highest rates of unplanned 30-day readmissions post-PCI.
- The primary drivers for readmission differ significantly across age groups, with non-cardiac conditions dominating in older populations.
- Developing age-tailored strategies is essential for effectively reducing readmissions following PCI.
Abstract:
It is unclear how age affects rates and causes of unplanned early readmissions after percutaneous coronary intervention (PCI). We analyzed patients in the Nationwide Readmission Database in the United States from 2010 to 2014 and examined the impact of age on readmissions after PCI. The primary outcomes were age-specific 30-day rates and causes of unplanned readmissions. A total of 2,294,345 procedures were analyzed with a 9.6% unplanned readmission rate within 30 days. Unplanned readmissions were 8.1%, 8.1%, 9.5%, and 12.6% for age groups <55, 55.0 to 64.9, 65.0-74.9, and ≥75 years, respectively. With increasing age, there was an increase in the rate of noncardiac causes for readmissions (for ages <55, 55.0 to 64.9, and ≥75 years, the rates were 54.1%, 54.8%, 56.6%, and 57.1%, respectively; p <0.001). Older age was associated with an increased prevalence of infections (13.9% ≥75 years vs 7.7% <55 years), gastrointestinal disease (11.5% ≥75 years vs 9.5% <55 years), and bleeding (7.4% ≥75 years vs 2.9% <55 years) as causes for noncardiac readmissions and a reduced prevalence of nonspecific chest pain (9.9% ≥75 years vs 31.4% <55 years). For cardiac causes, older age was associated with increased prevalence for readmissions due to heart failure (34.6% ≥75 years vs 11.9% <55 years) but a reduced prevalence of coronary artery disease, including angina (25.7% ≥75 years vs 51.3% <55 years). In conclusion, older patients have the highest rates of unplanned 30-day readmissions after PCI, with different causes for readmission compared with younger patients. Interventions designed to reduce readmissions after PCI should be age specific.
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