Advertisement

Gender Differences in the Rate of 30-Day Readmissions after Percutaneous Coronary Intervention for Acute Coronary Syndrome

Published:October 25, 2018DOI:https://doi.org/10.1016/j.whi.2018.09.002

      Abstract

      Background

      It has been reported that women have higher 30-day readmission rates than men after acute coronary syndrome (ACS). However, readmission after percutaneous coronary intervention (PCI) for ACS is a distinct subset of patients in whom gender differences have not been adequately studied.

      Methods

      Hawaii statewide hospitalization data from 2010 to 2015 were assessed to compare gender differences in 30-day readmission rates among patients hospitalized with ACS who underwent PCI during the index hospitalization. Readmission diagnoses were categorized using an aggregated version of the Centers for Medicare and Medicaid Services Condition Categories. Multivariable logistic regression was applied to evaluate the effect of gender on the 30-day readmission rate.

      Results

      A total of 5,354 patients (29.4% women) who were hospitalized with a diagnosis of ACS and underwent PCI were studied. Overall, women were older, with more identified as Native Hawaiian, and had a higher prevalence of cardiovascular risk factors compared with men. The 30-day readmission rate was 13.9% in women and 9.6% in men (p < .0001). In the multivariable model, female gender (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.09–1.60), Medicaid (OR, 1.48; 95% CI, 1.07–2.06), Medicare (1.72; 95% CI, 1.35–2.19), heart failure (1.88; 95% CI, 1.53–2.33), atrial fibrillation (OR, 1.54; 95% CI–1.21–1.95), substance use (OR, 1.88; 95% CI, 1.27–2.77), history of gastrointestinal bleeding (OR, 2.43; 95% CI, 1.29–4.58), and chronic kidney disease (OR, 1.78; 95% CI, 1.42–2.22) were independent predictors of 30-day readmissions. Readmission rates were highest during days 1 through 6 (peak, day 3) after discharge. The top three cardiac causes of readmissions were heart failure, recurrent angina, and recurrent ACS.

      Conclusions

      Female gender is an independent predictor of 30-day readmission after ACS that requires PCI. Our finding suggests women are at a higher risk of post-ACS cardiac events such as heart failure and recurrent ACS, and further gender-specific intervention is needed to reduce 30-day readmission rate in women after ACS.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Women's Health Issues
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ashton C.M.
        • Del Junco D.J.
        • Souchek J.
        • Wray N.P.
        • Mansyur C.L.
        The association between the quality of inpatient care and early readmission: A meta-analysis of the evidence.
        Medical Care. 1997; 35: 1044-1059
        • Ashton C.M.
        • Kuykendall D.H.
        • Johnson M.L.
        • Wray N.P.
        • Wu L.
        The association between the quality of inpatient care and early readmission.
        Annals of Internal Medicine. 1995; 122: 415-421
        • Ashton C.M.
        • Wray N.P.
        A conceptual framework for the study of early readmission as an indicator of quality of care.
        Social Science & Medicine. 1996; 43: 1533-1541
        • Benjamin E.J.
        • Blaha M.J.
        • Chiuve S.E.
        • Cushman M.
        • Das S.R.
        • Deo R.
        • Muntner P.
        • American Heart Association Statistics Committee and Stroke Statistics Subcommittee
        Heart disease and stroke statistics-2017 update: A report from the American Heart Association.
        Circulation. 2017; 135: e146-e603
        • Berger J.S.
        • Elliott L.
        • Gallup D.
        • Roe M.
        • Granger C.B.
        • Armstrong P.W.
        • Douglas P.S.
        Sex differences in mortality following acute coronary syndromes.
        JAMA. 2009; 302: 874-882
        • Dharmarajan K.
        • Hsieh A.F.
        • Lin Z.
        • Bueno H.
        • Ross J.S.
        • Horwitz L.I.
        • Krumholz H.M.
        Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia.
        JAMA. 2013; 309: 355-363
        • Dharmarajan K.
        • Wang Y.
        • Lin Z.
        • Normand S.T.
        • Ross J.S.
        • Horwitz L.I.
        • Krumholz H.M.
        Association of changing hospital readmission rates with mortality rates after hospital discharge.
        JAMA. 2017; 318: 270-278
        • Dreyer R.P.
        • Dharmarajan K.
        • Hsieh A.F.
        • Welsh J.
        • Qin L.
        • Krumholz H.M.
        Sex differences in trajectories of risk after rehospitalization for heart failure, acute myocardial infarction, or pneumonia.
        Circulation. Cardiovascular Quality and Outcomes. 2017; 10: e003271
        • Dreyer R.P.
        • Dharmarajan K.
        • Kennedy K.F.
        • Jones P.G.
        • Vaccarino V.
        • Murugiah K.
        • Krumholz H.M.
        Sex differences in 1-year all-cause rehospitalization in patients after acute myocardial infarction: A prospective observational study.
        Circulation. 2017; 135: 521-531
        • Dreyer R.P.
        • Ranasinghe I.
        • Wang Y.
        • Dharmarajan K.
        • Murugiah K.
        • Nuti S.V.
        • Krumholz H.M.
        Sex differences in the rate, timing, and principal diagnoses of 30-day readmissions in younger patients with acute myocardial infarction.
        Circulation. 2015; 132: 158-166
        • Dunlay S.M.
        • Weston S.A.
        • Killian J.M.
        • Bell M.R.
        • Jaffe A.S.
        • Roger V.L.
        Thirty-day rehospitalizations after acute myocardial infarction: A cohort study.
        Annals of Internal Medicine. 2012; 157: 11-18
        • Gupta A.
        • Wang Y.
        • Spertus J.A.
        • Geda M.
        • Lorenze N.
        • Nkonde-Price C.
        • Krumholz H.M.
        Trends in acute myocardial infarction in young patients and differences by sex and race, 2001 to 2010.
        Journal of the American College of Cardiology. 2014; 64: 337-345
        • Harrison P.L.
        • Hara P.A.
        • Pope J.E.
        • Young M.C.
        • Rula E.Y.
        The impact of postdischarge telephonic follow-up on hospital readmissions.
        Population Health Management. 2011; 14: 27-32https://doi.org/10.1089/pop.2009.0076
        • Hess C.N.
        • Kaltenbach L.A.
        • Doll J.A.
        • Cohen D.J.
        • Peterson E.D.
        • Wang T.Y.
        Race and sex differences in post-myocardial infarction angina frequency and risk of 1-year unplanned rehospitalization.
        Circulation. 2017; 135: 532-543
        • Izadnegahdar M.
        • Singer J.
        • Lee M.K.
        • Gao M.
        • Thompson C.R.
        • Kopec J.
        • Humphries K.H.
        Do younger women fare worse? Sex differences in acute myocardial infarction hospitalization and early mortality rates over ten years.
        Journal of Women's Health. 2014; 23: 10-17
        • Jencks S.F.
        Defragmenting care.
        Annals of Internal Medicine. 2010; 153: 757-758
        • Khera R.
        • Jain S.
        • Pandey A.
        • Agusala V.
        • Kumbhani D.J.
        • Das S.R.
        • Girotra S.
        Comparison of readmission rates after acute myocardial infarction in 3 patient age groups (18 to 44, 45 to 64, and >/=65 Years) in the United States.
        American Journal of Cardiology. 2017; 120: 1761-1767
        • Kocher R.P.
        • Adashi E.Y.
        Hospital readmissions and the Affordable Care Act: Paying for coordinated quality care.
        Journal of the American Medical Association. 2011; 306: 1794-1795
        • Lauffenburger J.C.
        • Robinson J.G.
        • Oramasionwu C.
        • Fang G.
        Racial/Ethnic and gender gaps in the use of and adherence to evidence-based preventive therapies among elderly Medicare Part D beneficiaries after acute myocardial infarction.
        Circulation. 2014; 129: 754-763
        • McManus D.D.
        • Nguyen H.L.
        • Saczynski J.S.
        • Tisminetzky M.
        • Bourell P.
        • Goldberg R.J.
        Multiple cardiovascular comorbidities and acute myocardial infarction: Temporal trends (1990-2007) and impact on death rates at 30 days and 1 year.
        Clinical Epidemiology. 2012; 4: 115-123
        • Mehta L.S.
        • Beckie T.M.
        • DeVon H.A.
        • Grines C.L.
        • Krumholz H.M.
        • Johnson M.N.
        • Outcomes Research
        Acute myocardial infarction in women: A scientific statement from the American Heart Association.
        Circulation. 2016; 133: 916-947
        • Nguyen H.L.
        • Saczynski J.S.
        • Gore J.M.
        • Goldberg R.J.
        Age and sex differences in duration of prehospital delay in patients with acute myocardial infarction: A systematic review.
        Circulation Cardiovascular Quality and Outcomes. 2010; 3: 82-92
        • Numasawa Y.
        • Kohsaka S.
        • Miyata H.
        • Noma S.
        • Suzuki M.
        • Ishikawa S.
        • Fukuda K.
        Gender differences in in-hospital clinical outcomes after percutaneous coronary interventions: An insight from a Japanese multicenter registry.
        PLoS One. 2015; 10: e0116496
        • Nuti S.V.
        • Qin L.
        • Rumsfeld J.S.
        • Ross J.S.
        • Masoudi F.A.
        • Normand S.L.
        • Krumholz H.M.
        Association of admission to veterans affairs hospitals vs non-veterans affairs hospitals with mortality and readmission rates among older men hospitalized with acute myocardial infarction, heart failure, or pneumonia.
        Journal of the American Medical Association. 2016; 315: 582-592
        • O'Brien C.
        • Valsdottir L.
        • Wasfy J.H.
        • Strom J.B.
        • Secemsky E.A.
        • Wang Y.
        • Yeh R.W.
        Comparison of 30-day readmission rates after hospitalization for acute myocardial infarction in men versus women.
        American Journal of Geriatric Cardiology. 2017; 120: 1070-1076
        • Ranasinghe I.
        • Wang Y.
        • Dharmarajan K.
        • Hsieh A.F.
        • Bernheim S.M.
        • Krumholz H.M.
        Readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia among young and middle-aged adults: A retrospective observational cohort study.
        PLoS Medicine. 2014; 11: e1001737
        • Shah A.S.
        • Griffiths M.
        • Lee K.K.
        • McAllister D.A.
        • Hunter A.L.
        • Ferry A.V.
        • Mills N.L.
        High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: Prospective cohort study.
        BMJ (Clinical Research Ed.). 2015; 350: g7873

      Biography

      Luke Lam, MD, is a senior cardiology fellow at the University of Hawaii Cardiovascular Disease Fellowship Program.

      Biography

      Hyeong Jun Ahn, PhD, is an Assistant Professor and biostatistician at the University of Hawaii Office of Biostatistics and Quantitative Health Sciences.

      Biography

      Kazue Okajima MD, PhD, is a senior cardiology fellow at the University of Hawaii Cardiovascular Disease Fellowship Program.

      Biography

      Katie Schoenman, DO, is a senior cardiology fellow at the University of Hawaii Cardiovascular Disease Fellowship Program.

      Biography

      Todd B. Seto, MD, is an Associate Professor at the University of Hawaii John A. Burns School of Medicine. His research focuses on noninvasive cardiology and outcomes research.

      Biography

      Ralph V. Shohet, MD, is a Professor of Medicine and Director of the Center for Cardiovascular Research at University of Hawaii John A. Burns School of Medicine. His research focuses on exploring the response of the stressed heart in mouse models.

      Biography

      Jill Miyamura, PhD, is the Vice President and Senior Research Officer, Hawaii Health Information Corporation.

      Biography

      Tetine L. Sentell, PhD, is an Associate Professor at the University of Hawaii Office of Public Health Studies. Her research focuses on racial and ethnic disparities in health care access, quality, and outcomes.

      Biography

      Kazuma Nakagawa, MD, is an Associate Professor of Medicine at the University of Hawaii John A. Burns School of Medicine. He is also the Director of Stroke Center and Medical Director of Obstetric Neurovascular Service at The Queen's Medical Center.