Causes, Trends, and Predictors of 90-Day Readmissions After Spontaneous Coronary Artery Dissection (from A Nationwide Readmission Database)

Document Type

Article

Abstract

Spontaneous coronary artery dissection (SCAD) is a frequently missed diagnosis in patients presenting with acute coronary syndrome (ACS). Our aim was to evaluate the causes, trends, and predictors of 90-day hospital readmission in patients presenting with SCAD. The Nationwide Readmissions Database (2013 to 2014) was utilized to identify patients with primary discharge diagnosis of SCAD using the International Classification of Diseases, Ninth Revision, Clinical Modification, diagnostic code 414.12. The primary outcome was 90-day readmission. Among 11,228 patients admitted with the primary diagnosis of SCAD, 2,424 patients (21.6%) were readmitted within 90 days (68% women, 82% <65 years of age). Common causes for 90-day readmission were ACS (25%), acute heart failure (11%), acute respiratory failure (7%), and arrhythmias (5%). Multivariate predictors of 90-day readmissions were hypertension, chronic obstructive pulmonary disease, peripheral arterial disease, discharge to facility and increased length of stay (LOS) during index admission. Multivariate predictors of increased healthcare-related costs were older age, female gender, discharge to facility, and increased LOS. Over half of the readmissions (52%) occurred in first 30 days after discharge. In conclusion, we found a high rate of rehospitalization among SCAD patients, particularly within the first 30 days of index hospitalization. ACS, heart failure, and acute respiratory failure were the most common reasons for readmission. Hypertension, chronic obstructive pulmonary disease, peripheral arterial disease, and increased LOS were independent predictors of readmission. Further studies are warranted to confirm these predictors of readmission in this high-risk population.

Medical Subject Headings

Acute Coronary Syndrome (diagnosis, epidemiology); Adolescent; Adult; Aged; Coronary Angiography; Coronary Vessel Anomalies (diagnosis, epidemiology); Databases, Factual; Diagnosis, Differential; Female; Follow-Up Studies; Heart Failure (diagnosis, epidemiology); Humans; Incidence; Male; Middle Aged; Patient Readmission (trends); Respiratory Insufficiency (diagnosis, epidemiology); Retrospective Studies; Risk Factors; Time Factors; United States (epidemiology); Vascular Diseases (congenital, diagnosis, epidemiology); Young Adult

Publication Date

11-1-2019

Publication Title

The American journal of cardiology

E-ISSN

1879-1913

Volume

124

Issue

9

First Page

1333

Last Page

1339

PubMed ID

31551116

Digital Object Identifier (DOI)

10.1016/j.amjcard.2019.07.058

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