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.
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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.
Article info
Publication history
Published online: October 25, 2018
Accepted:
September 6,
2018
Received in revised form:
August 27,
2018
Received:
May 26,
2018
Footnotes
Conflict of Interest/Disclosure: None.
Sources of Funding: The research described was supported by National Institute on Minority Health and Health Disparities (NIMHD) Grant P20 MD000173, U54MD00760131, and was also supported in part by NIMHD grant U54MD007584 and National Institute of General Medical Sciences (NIGMS) grants GM103341 and GM113134, and grant RO1HS019990 from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services.
Identification
Copyright
© 2018 Jacobs Institute of Women's Health. Published by Elsevier Inc.
