10% of Stent, Angioplasty Patients Re-Hospitalized

In 10% of the cases, angioplasty and stent patients require re-hospitalization. Angioplasty, which usually involves heart stents to widen blocked blood vessels, is prescribed to clear arteries.

A study of over 15,000 patients who underwent a percutaneous coronary intervention (PCI), such as a balloon angioplasty or stent placement, found that about one in 10 patients were re-admitted to the hospital within 30 days and suffered an increased risk of death within one year, said Science Daily. The study was published by the JAMA/Archive journal, the Archives of Internal Medicine.

“Thirty-day readmission rates have become a quality performance measure, and the Center for Medicare and Medicaid Services (CMS) publicly reports hospital-level, 30-day, risk-standardized readmission rates for patients hospitalized with congestive heart failure (CHF), acute myocardial infarction [AMI; heart attack], and for patients undergoing PCI,” according background study information, Science Daily reported.

The study was conducted by Farhan J. Khawaja, M.D., of the Mayo Clinic and Mayo Foundation, and colleagues to determine factors linked with 30-day readmission rates, how those rates relate to one-year morality for PCI patients, and the cause for readmission, said Science Daily. The study revealed 15,498 PCI hospitalizations for either elective or acute coronary syndromes, from January 1998 through June 2008. A number of models were utilized to “estimate the adjusted association between demographic, clinical, and procedural variables and 30-day readmission and 1-year mortality,” said Science Daily.

The researchers learned that 1,459 patients who underwent PCIs (9.4%) were re-admitted within 30 days; 106 patients died (0.68%), including 33 deaths during or following readmission and 73 not linked to readmission. Of the patients readmitted within 30 days, 1,003 (69%) were readmitted for heart-related reasons, said Science Daily. After adjusting for a number of factors, patients re-admitted within 30 days experienced increased death risks at one year.

“Thirty-day risk-standardized readmission rates after PCI have become a publicly reported performance measure, and there is high interest from hospitals and clinicians to understand and improve modifiable factors associated with 30-day readmission rates,” the researchers wrote, said Science Daily. “Lack of early follow-up has been associated with increased risk of readmission among patients with heart failure and may also be playing a role in patients undergoing PCI. Early follow-up allows patients and clinicians to ensure understanding and compliance, and to gauge the effectiveness of therapies.”

We recently wrote that procedures such as angioplasty could cause harm in healthy patients, citing John Santa, MD, MPH, director of the Consumer Reports Health Ratings Center. “We know that obstructions caused by plaque in the arteries are actually very common, even in young, healthy adults,” Santa told Web MD previously. “While these tests are very appropriate in people with symptoms, they clearly lead to the overuse of invasive treatments in people who do not have symptoms,” Dr. Santa added.

Some 600,000 angioplasties with and without stents are performed in the U.S. annually, costing over $12 billion. A recent review of over 500,000 procedures revealed that about half are performed in patients with minimal or no symptoms and were questionable or inappropriate. Angioplasty with stents can result in clotting, which can increase heart attack and stroke risks in people with no heart symptoms, said Kimberly Lovett, MD, of the San Diego Center for Patient Safety at the University of California, San Diego.

Citing a similar study, we recently wrote that Steven Nissen, head of cardiovascular medicine at the Cleveland Clinic, told The Wall Street Journal that that study tends to confirm concerns that many people have expressed, ”that there are many thousands of patients who undergo coronary interventions for very questionable indications.”

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