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Li L, Zhang H, Rao C, Meng J, Zhou X, Liu C, Fan H. Clinical Outcomes of Surgical Revascularization Strategies Guided by Quantitative Flow Ratio in Primary Noncoronary Cardiac Surgery. J Thorac Imaging 2024:00005382-990000000-00135. [PMID: 38686813 DOI: 10.1097/rti.0000000000000783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
PURPOSE Information regarding quantitative flow ratio (QFR) usage in coronary artery bypass grafting (CABG) is lacking. We compared the incidence of postoperative long-term adverse cardiovascular and cerebrovascular events after QFR-guided or coronary angiography-guided adult cardiac surgery with concurrent bypass surgery. MATERIALS AND METHODS This study included 432 patients who underwent cardiopulmonary bypass (CPB) at our institution with at least 1 angiographical coronary artery lesion (diameter stenosis: 30% to 90%) between January 2015 and January 2016. The QFR of each patient was calculated. Patients who only underwent intraoperative coronary revascularization following the principles of optimal revascularization strategy were assigned to group A. Patients with coronary lesions not meeting the above criteria were placed in group B. RESULTS The average number of distal anastomoses of patients with combined CABG in group B was similar to that in Group A (1.9±1.0 vs. 1.7±0.9; P=0.081). Group A had a shorter CPB duration (114.4±49.2 vs 135.8±55.2 minutes; P<0.001) and shorter aortic cross-clamping time (83.6±36.2 vs 101.1±40.6 minutes; P<0.001). The rates of perioperative mortality and major complications did not differ between groups. Long-term major adverse cardiovascular and cerebrovascular events (MACCEs) were less common in group A than in group B (14.7% vs 29.5%; P<0.001). CONCLUSIONS In primary noncoronary cardiac surgery, despite the similar average numbers of distal anastomoses, the group with target vessels treated using an optimal coronary revascularization strategy presented shorter CPB time and aortic cross-clamping time than the other group. Multivariate analyses also showed a lower incidence of long-term MACCEs.
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Affiliation(s)
- Linlin Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Cimci M, Polad J, Mamas M, Iniguez-Romo A, Chevalier B, Abhaichand R, Aminian A, Roguin A, Maluenda G, Angioi M, Cassel G, Kuramitsu S, Jacobs L, Debrus R, Malik F, Hildick-Smith D, Laanmets P, Roffi M. Outcomes and regional differences in practice in a worldwide coronary stent registry. Heart 2022; 108:1310-1318. [PMID: 35012960 PMCID: PMC9340045 DOI: 10.1136/heartjnl-2021-320116] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 11/08/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The primary objective was to assess the performance of a new generation thin-strut sirolimus-eluting coronary stent with abluminal biodegradable polymer in an all comer population. The secondary objective was to detail differences in contemporary percutaneous coronary intervention (PCI) practice worldwide. METHODS e-Ultimaster was an all-comer, prospective, global registry (NCT02188355) with independent event adjudication enrolling patients undergoing PCI with the study stent. The primary outcome measure was target lesion failure (TLF) at 1 year, defined as the composite of cardiac death, target vessel myocardial infarction and clinically driven target lesion revascularisation. Data were stratified according to 4 geographical regions. RESULTS A total of 37 198 patients were enrolled (Europe 69.2%, Asia 17.8%, Africa/Middle East 6.6% and South America/Mexico 6.5%) and 1-year follow-up was available for 35 389 patients (95.1%). One-year TLF occurred in 3.2% of the patients, ranging from 2% (Africa/Middle East) to 4.1% (South America/Mexico). In patients with acute coronary syndrome, potent P2Y12 inhibitors were prescribed in 48% of patients at discharge, while at 1 year 72% were on any dual antiplatelet therapy. Lipid-lowering treatment was administered in 80.9% and 75.5% of patients at discharge and 1 year, respectively. Regional differences in the profile of the treated patients as well as in PCI practice were reported. CONCLUSIONS In this investigation with worldwide representation, contemporary PCI using a new generation thin-strut sirolimus-eluting coronary stent with abluminal biodegradable polymer was associated with low 1-year TLF across clinical presentations and continents. Suboptimal adherence to current recommendations around antiplatelet and lipid lowering treatments was detected.
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Affiliation(s)
- Murat Cimci
- Division of Cardiology, University Hospitals Geneva, Geneva, Switzerland
| | - Jawed Polad
- Department of Cardiology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Keele, UK.,Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, UK
| | | | - Bernard Chevalier
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Rajpal Abhaichand
- Department of Cardiology, GKNM Hospital, Coimbatore, Tamil Nadu, India
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Ariel Roguin
- Departmement of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel.,Faculty of Medicine, Technion Israel Institute of Technology The Ruth and Bruce Rappaport, Haifa, Israel
| | - Gabriel Maluenda
- Cardiology, Hospital Clinico San Borja Arriaran, Santiago, Chile
| | | | - Graham Cassel
- Netcare Milpark Hospital, Johannesburg, South Africa
| | | | - Lotte Jacobs
- Medical and Clinical Division, Terumo Europe NV, Leuven, Belgium
| | - Roxane Debrus
- Medical and Clinical Division, Terumo Europe NV, Leuven, Belgium
| | - Fazila Malik
- National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | | | - Peep Laanmets
- North Estonia Medical Centre Foundation, Tallinn, Estonia
| | - Marco Roffi
- Division of Cardiology, University Hospitals Geneva, Geneva, Switzerland
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Sakai-Bizmark R, Ross MG, Estevez D, Bedel LEM, Marr EH, Tsugawa Y. Evaluation of Hospital Cesarean Delivery-Related Profits and Rates in the United States. JAMA Netw Open 2021; 4:e212235. [PMID: 33739430 PMCID: PMC7980096 DOI: 10.1001/jamanetworkopen.2021.2235] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE A high cesarean delivery rate in US hospitals indicates the potential overuse of this procedure; however, underlying causes of the excessive use of cesarean procedures in the US have not been fully understood. OBJECTIVE To investigate the association between the probability of cesarean delivery at the patient-level and profit per procedure from cesarean deliveries. DESIGN, SETTING, AND PARTICIPANTS This observational, cross-sectional study used a nationally representative sample of hospital discharge data from women at low risk for cesarean birth who delivered newborns between 2010 and 2014 in the US. Data were gathered from the Nationwide Readmissions Database from the Healthcare Cost and Utilization Project, compiled by the Agency for Healthcare Research and Quality. Data cleaning and analyses were conducted between August 2019 and May 2020. EXPOSURES Hospital-level median value of profits from cesarean deliveries, defined as the difference between the charge and the cost for cesarean delivery calculated for each hospital. MAIN OUTCOMES AND MEASURES Our primary outcome was the individual-level probability of undergoing a cesarean delivery. We examined the association with the hospital-level median value of profits per procedure for cesarean delivery (defined as the difference between the charge and the cost for cesarean delivery) using hierarchical regression models adjusted for patient and hospital characteristics and year-fixed effects. RESULTS A total of 13 215 853 deliveries were included in our analyses (mean [SE] age, 27.4 [0] years), of which 2 202 632 (16.7%) were cesarean deliveries. After adjusting for potential confounders, pregnant women were more likely to have a cesarean birth when they delivered at hospitals with higher profits per procedure from cesarean deliveries. Women cared for at hospitals with the highest (adjusted odds ratio, 1.08; 95% CI, 1.02-1.14; P = .005) and second-highest profit quartiles (adjusted odds ratio, 1.07; 95% CI, 1.02-1.13; P = .007) had higher probabilities of a cesarean delivery compared with those cared for at hospitals in the lowest profit quartile. CONCLUSIONS AND RELEVANCE In this cross-sectional study of US nationally representative hospital discharge data, hospitals with higher profits per cesarean procedure were associated with an increased probability of delivering newborns through cesarean birth. These findings highlight the potential influence financial incentives play in determining a high cesarean delivery rate in the US.
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Affiliation(s)
- Rie Sakai-Bizmark
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
- Department of Pediatrics, Harbor-UCLA Medical Center and David Geffen School of Medicine, University of California, Los Angeles, Torrance
| | - Michael G. Ross
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
- Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center and David Geffen School of Medicine, University of California, Los Angeles, Torrance
| | - Dennys Estevez
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Lauren E. M. Bedel
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Emily H. Marr
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles
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Trends, Predictors, and Outcomes Associated With 30-Day Hospital Readmissions After Percutaneous Coronary Intervention in a High-Volume Center Predominantly Using Radial Vascular Access. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1525-1531. [DOI: 10.1016/j.carrev.2020.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/18/2020] [Indexed: 11/22/2022]
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Gaddam A, Ajibawo T, Ravat V, Yomi T, Patel RS. In-Hospital Mortality Risk in Post-Percutaneous Coronary Interventions Cancer Patients: A Nationwide Analysis of 1.1 Million Heart Disease Patients. Cureus 2020; 12:e9071. [PMID: 32782887 PMCID: PMC7413566 DOI: 10.7759/cureus.9071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives The primary goal of this inpatient study is to assess the risk of in-hospital mortality due to cancer and chronic comorbidities in post-percutaneous coronary intervention (PCI) patients. Methods We conducted a retrospective cross-sectional study, including 1,131,415 adult patients (age +18 years) by using the Nationwide Inpatient Sample (NIS) from 2012 to 2014. These patients underwent PCI, and they were further sub-grouped by the co-diagnosis of cancer. Logistic regression analysis was used to evaluate the risk of association between comorbid cancer and in-hospital mortality in post-PCI inpatients. Results Most PCI inpatients with cancer were older adults (mean age 70.6 years), males (71.8%), and white (80.6%). Post-PCI mortality risk was 1.28 times higher in females (95% CI 1.235 - 1.335) as compared to males. Coagulopathy and anemias significantly increased the risk of post-PCI mortality by three times (95% CI 2.837 - 3.250) and 1.6 times (95% CI 1.534 - 1.692), respectively. Comorbid cancer was associated with an increased risk of in-hospital mortality in post-PCI patients by 1.9 times (95% CI 1.686 - 2.086) after controlling for demographic confounders and chronic comorbidities. Conclusion Our analysis showed that cancer is an independent risk factor for in-hospital mortality after PCI. This association calls for an integrated care model in the management of a complex patient population with cancer and other comorbidities requiring more vigilance and aggressive management.
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Affiliation(s)
- Anusha Gaddam
- Internal Medicine, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, IND
| | - Temitope Ajibawo
- Internal Medicine, Brookdale University Hospital Medical Center, New York City, USA
| | | | - Timiiye Yomi
- Medicine, University of Benin School of Medicine, Benin City, NGA
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Kwok CS, Alraies MC, Mohamed M, Rashid M, Shoaib A, Nolan J, Ratib K, Khoo CW, Kontopantelis E, Mamas MA. Rates, predictors and the impact of cannabis misuse on in-hospital outcomes among patients undergoing percutaneous coronary intervention (from the National Inpatient Sample). Int J Clin Pract 2020; 74:e13477. [PMID: 31922638 DOI: 10.1111/ijcp.13477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/29/2019] [Accepted: 01/07/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Whether cannabis use worsens outcomes in coronary heart disease is unknown and no previous study has evaluated the outcomes for patients who undergo percutaneous coronary intervention (PCI) according to cannabis use. METHODS We analysed patients in the National Inpatient Sample between 2004 and 2014 who underwent PCI and evaluated rates, predictors and outcomes of patients according to cannabis misuse defined by cannabis abuse or dependence. RESULTS A total of 7 306 012 patients were included and 32 765 cannabis misusers (0.4%). Cannabis misusers were younger (49.5 vs 64.6 years, P < .001) and were more likely to be male (82.7% vs 66.3%, P < .001). There was also a greater proportion of patients who were of black ethnicity in the cannabis misuse group (27.7% vs 7.9%, P < .001) and fewer elective admissions (7.8% vs 27.6%, P < .001). There was no difference in in-hospital mortality (OR 1.06 95% CI 0.80-1.40, P = .67), bleeding (OR 0.94 95% CI 0.77-1.15, P = .55) and stroke/transient ischaemic attack (OR 1.19 95% CI 0.98-1.45, P = .084) compared with non-cannabis misusers. Cannabis misusers had significantly lower odds of in-hospital vascular complications (OR 0.73 95% CI 0.58-0.90, P = .004). CONCLUSIONS Our results suggest that cannabis misusers are more likely to be male, of black ethnicity and from the lowest quartile of income, but there was no evidence that cannabis misuse is associated with worse periprocedural outcomes following PCI when controlling for key proxies of health status.
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Affiliation(s)
- Chun Shing Kwok
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - M Chadi Alraies
- Detroit Medical Center, Detroit Heart Hospital, Wayne State University, Detroit, MI, USA
| | - Mohamed Mohamed
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Ahmad Shoaib
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - James Nolan
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Karim Ratib
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Chee W Khoo
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | | | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
- University of Manchester, Manchester, UK
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Camerini F, Fabris E, Sinagra G. Appropriateness, inappropriateness and waste of resources: Unfulfilled expectations? Eur J Intern Med 2019; 63:15-18. [PMID: 31006508 DOI: 10.1016/j.ejim.2019.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Fulvio Camerini
- Cardiovascular Department, University of Trieste, Trieste, Italy
| | - Enrico Fabris
- Cardiovascular Department, University of Trieste, Trieste, Italy
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Kwok CS, Rao SV, Gilchrist IC, Potts J, Nagaraja V, Gunning M, Nolan J, Kontopantelis E, Bertrand OF, Mamas MA. Relation of Length of Stay to Unplanned Readmissions for Patients Who Undergo Elective Percutaneous Coronary Intervention. Am J Cardiol 2019; 123:33-43. [PMID: 30539746 DOI: 10.1016/j.amjcard.2018.09.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/05/2018] [Accepted: 09/11/2018] [Indexed: 12/29/2022]
Abstract
The cost of inpatient percutaneous coronary interventions (PCI) procedure is related to length of stay (LOS). It is unknown, how LOS may be associated with readmission rates and costs of index PCI and readmissions in elective PCI. This study aims to evaluate rates, predictors, causes, and costs associated with 30-day unplanned readmissions according to lLOS in patients, who underwent elective PCI. We included patients in the Nationwide Readmission Database, who were admitted to hospital from 2010 to 2014, who underwent uncomplicated elective PCI. LOS was defined as 0, 1, 2, and ≥3 days. A total of 324,345 patients were included in the analysis and the 30-day unplanned readmission was 4.75%, 4.67%, 6.44%, and 9.42% in the LOS groups 0, 1, 2, and ≥3 days, respectively. Prolonged LOS was associated with increased average total 30-day cost (index and readmission cost, 0 days $15,063, 1 day $14,693, 2 days $18,136, and ≥3 days $24,336). Compared with 0 days, the odds of readmissions were greater for 2 days (odds ratio 1.41, 95% confidence interval 1.07 to 1.87, p = 0.016) and ≥3 days (odds ratio 1.70, 95% confidence interval 1.28 to 2.24, p <0.001). Comorbidities were strong predictors of LOS and noncardiac causes, account for more than half of all causes for readmission. Longer LOS was associated with reduced incidence of readmissions for noncardiac causes such as noncardiac chest pain, but a greater rate of readmissions for heart failure. In conclusion, shorter length of stay was associated with reduced healthcare costs in elective PCI.
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Affiliation(s)
- Chun Shing Kwok
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Sunil V Rao
- The Duke Clinical Research Institute, Durham, North Carolina
| | - Ian C Gilchrist
- Pennsylvania State University, Heart & Vascular Institute, Hershey, Pennsylvania
| | - Jessica Potts
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom
| | - Vinayak Nagaraja
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom
| | - Mark Gunning
- Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - James Nolan
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | | | - Olivier F Bertrand
- Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.
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Cesaro A, Gragnano F, Di Girolamo D, Moscarella E, Diana V, Pariggiano I, Alfieri A, Perrotta R, Golino P, Cesaro F, Mercone G, Campo G, Calabrò P. Functional assessment of coronary stenosis: an overview of available techniques. Is quantitative flow ratio a step to the future? Expert Rev Cardiovasc Ther 2018; 16:951-962. [DOI: 10.1080/14779072.2018.1540303] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Arturo Cesaro
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Felice Gragnano
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Domenico Di Girolamo
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
| | - Elisabetta Moscarella
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Vincenzo Diana
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Ivana Pariggiano
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Alfonso Alfieri
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
| | - Rocco Perrotta
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
| | - Pasquale Golino
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
| | - Francesco Cesaro
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
| | - Giuseppe Mercone
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Paolo Calabrò
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Kwok CS, Rao SV, Gilchrist I, Martinez SC, Al Ayoubi F, Potts J, Rashid M, Kontopantelis E, Myint PK, Mamas MA. Relation Between Age and Unplanned Readmissions After Percutaneous Coronary Intervention (Findings from the Nationwide Readmission Database). Am J Cardiol 2018; 122:220-228. [PMID: 29861049 DOI: 10.1016/j.amjcard.2018.03.367] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/21/2018] [Accepted: 03/27/2018] [Indexed: 11/17/2022]
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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Affiliation(s)
- Chun Shing Kwok
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.
| | - Sunil V Rao
- Department of Cardiology, Duke Clinical Research Institute, Durham, North Carolina
| | - Ian Gilchrist
- Division of Interventional Cardiology, Penn State Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Sara C Martinez
- Division of Cardiology, Providence St. Peter Hospital, Olympia, Washington
| | - Fakhr Al Ayoubi
- Department of Cardiac Sciences KFCC, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Jessica Potts
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom
| | - Evangelos Kontopantelis
- Faculty of Biology Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Phyo K Myint
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
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Kwok CS, Potts J, Gulati M, Alasnag M, Rashid M, Shoaib A, Ul Haq MA, Bagur R, Mamas MA. Effect of Gender on Unplanned Readmissions After Percutaneous Coronary Intervention (from the Nationwide Readmissions Database). Am J Cardiol 2018; 121:810-817. [PMID: 29448978 DOI: 10.1016/j.amjcard.2017.12.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/13/2017] [Accepted: 12/27/2017] [Indexed: 11/28/2022]
Abstract
Women who undergo percutaneous coronary intervention (PCI) are at higher risk of adverse outcomes compared with men, but it is unknown whether gender affects early unplanned rehospitalization. We analyzed 832,753 patients who underwent PCI from 2013 to 2014 in the Nationwide Readmissions Database. We compared gender differences in incidences, predictors, causes, and cost of unplanned 30-day readmissions and examined the effect of co-morbidity. A total of 832,753 men and women who survived the index PCI and were not admitted for a planned readmission were included in the analysis. Overall, 9.4% of patients had an unplanned readmission within 30 days. Thirty-day readmission rates were higher in women compared with men (11.5% vs 8.4%, p <0.001) even after multivariate adjustment (odds ratio 1.19, 95% confidence interval 1.16 to 1.22, p <0.001), although women had significantly lower costs associated with the readmission ($11,927 vs $12,758, p <0.001). The cause of readmission for women and men were similar and the majority of the readmissions were due to noncardiac causes (58% vs 55%), the most common of which were nonspecific chest pain, gastrointestinal disease, and infections. In contrast, for cardiac readmissions, women are more likely to be readmitted for heart failure (29.64% vs 22.34%), whereas men are more likely to be readmitted for coronary artery disease, including angina (33.47% vs 28.54%). In conclusion, gender disparities exist in rates of unplanned rehospitalization after PCI, where more than 1 in 10 women who undergo PCI are readmitted within 30 days. Gender differences were not observed for causes of noncardiac readmissions, whereas important differences were observed for cardiovascular causes.
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Affiliation(s)
- Chun Shing Kwok
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom; Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.
| | - Jessica Potts
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
| | - Martha Gulati
- Division of Cardiology, University of Arizona, Phoenix, Arizona
| | - Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
| | - Ahmad Shoaib
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
| | - Muhammad Ayyaz Ul Haq
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
| | - Rodrigo Bagur
- Division of Cardiology, London Health Sciences Centre, Department of Medicine, and Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Mamas Andreas Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom; Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
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12
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Brownlee S, Chalkidou K, Doust J, Elshaug AG, Glasziou P, Heath I, Nagpal S, Saini V, Srivastava D, Chalmers K, Korenstein D. Evidence for overuse of medical services around the world. Lancet 2017; 390:156-168. [PMID: 28077234 PMCID: PMC5708862 DOI: 10.1016/s0140-6736(16)32585-5] [Citation(s) in RCA: 535] [Impact Index Per Article: 76.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 06/29/2016] [Accepted: 07/18/2016] [Indexed: 12/17/2022]
Abstract
Overuse, which is defined as the provision of medical services that are more likely to cause harm than good, is a pervasive problem. Direct measurement of overuse through documentation of delivery of inappropriate services is challenging given the difficulty of defining appropriate care for patients with individual preferences and needs; overuse can also be measured indirectly through examination of unwarranted geographical variations in prevalence of procedures and care intensity. Despite the challenges, the high prevalence of overuse is well documented in high-income countries across a wide range of services and is increasingly recognised in low-income countries. Overuse of unneeded services can harm patients physically and psychologically, and can harm health systems by wasting resources and deflecting investments in both public health and social spending, which is known to contribute to health. Although harms from overuse have not been well quantified and trends have not been well described, overuse is likely to be increasing worldwide.
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Affiliation(s)
- Shannon Brownlee
- Lown Institute, Brookline, MA, USA; Department of Health Policy, Harvard T.H. Chan School of Public Health, Cambridge, MA, USA.
| | - Kalipso Chalkidou
- Institute for Global Health Innovation, Imperial College, London, UK
| | - Jenny Doust
- Center for Research in Evidence-Based Practice, Bond University, Gold Coast, QLD, Australia
| | - Adam G Elshaug
- Lown Institute, Brookline, MA, USA; Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Paul Glasziou
- Center for Research in Evidence-Based Practice, Bond University, Gold Coast, QLD, Australia
| | - Iona Heath
- Royal College of General Practitioners, London, UK
| | | | | | - Divya Srivastava
- LSE Health, London School of Economics and Political Science, London, UK
| | - Kelsey Chalmers
- Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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13
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Dehmer GJ, White L, Doherty JU. Appropriate Use Criteria and the Imaging Mandate. US CARDIOLOGY REVIEW 2017. [DOI: 10.15420/usc.2017:29:1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Appropriate use criteria (AUC) have existed for over 30 years and are being deployed with increasing frequency to study the delivery of healthcare. The goal of AUC is to advise all stakeholders about the reasonable use of testing procedures or therapies to improve symptoms, quality of life, and health outcomes. Numerous studies have shown the favorable effects of AUC to limit the overuse of unnecessary procedures while also promoting high-quality clinical care and cost savings. AUC evaluating only a single imaging modality have been replaced by multimodality documents, making it easier for the clinician to evaluate the appropriateness of multiple imaging methods in various clinical scenarios. The Protecting Access to Medicare Act of 2014 contained language mandating the use of AUC when ordering certain advanced cardiac imaging tests, and this requirement is currently scheduled for implementation in January 2020. Clinicians need to be aware of the increasing use of AUC and the financial implications of the AUC mandate legislation.
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14
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Affiliation(s)
- Mani Arsalan
- From Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany (M.A.); and The Heart Hospital Baylor Plano, Baylor Scott and White Health, Plano, TX (M.A., M.J.M.)
| | - Michael J Mack
- From Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany (M.A.); and The Heart Hospital Baylor Plano, Baylor Scott and White Health, Plano, TX (M.A., M.J.M.).
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