Pulmonary Embolism Readmission Trend Over the Years: A National Readmission Database Study

Introduction: Acute pulmonary embolism (PE) is known to be associated with significant short-term and long-term complications. However, with the evolution of PE management, the outcomes of PE-related complications and the need for readmission have not been well studied. The aim of this study is to see the trend in readmissions in PE patients from the years 2010 to 2018. Methods: We utilized the National Readmission Database from 2010 to 2018 to identify hospitalized patients with a principal diagnosis of acute pulmonary embolism. Identified the total number of readmissions for acute PE from 2010 to 2018. A multivariate cox regression model was used to identify independent predictors of readmission. Results: The number of patients with 30-day readmissions has gradually increased from 14,508 in 2010 to 19,703 in 2018. The proportion of females admitted was higher than males in all years. The 30-day all-cause readmission after principal admission for PE decreased from 11.2% to 9.7% from 2010 to 2014 but increased to 11.8% in 2018 (p<0.001). Risk-adjusted readmission specific for PE showed a decrease from 1.2 to 1% (p=0.023) from 2010 to 2018. When adjusted to age and gender, an increase in the proportion of readmissions with intracranial bleeding was seen among both the 30-day (0.7% in 2010 to 1.2% in 2018, aOR 1.06, p<0.001) and 90-day (0.7% in 2010 to 1.2% in 2018, aOR 1.06, p-trend 0.003) cohorts. Similarly, an increasing trend of readmissions for UGI bleed was seen among both 30-day (0.9% vs 4.3%, aOR=1.26, p-trend <0.001) and 90-day readmissions (0.7% vs 3.8%, aOR=1.27, p-trend <0.001). The units of blood transfusion required per readmission reduced in both cohorts during the study period. Conclusion: Our study suggests that there is a statistically significant decrease in PE-specific readmission from 2010 to 2018, but an increase in all-cause readmissions. We also report an increase in non-major bleeding during readmissions, including ICH and UGI bleed. These findings warrant further studies to elucidate the mechanism for decreasing PE-specific readmission but possible causes for the increase in all-cause readmission in the hope of optimizing management and continuing improving outcomes.

Impact of chronic kidney disease on in-hospital mortality and clinical outcomes of catheter ablation of ventricular tachycardia: Insights from the national readmission database

Background: Catheter ablation is an effective treatment for ventricular tachycardia (VT), albeit the decision to undergo this procedure is often influenced by underlying comorbidities. The present study aims at evaluating the effects of chronic kidney disease (CKD) on clinical outcomes of VT ablation. Methods: We identified 7,212 patients who presented between 2016-2018 and underwent catheter ablation for VT. Their clinical data were retrospectively accrued from the national readmission database (NRD) using the corresponding diagnosis codes. We compared clinical outcomes between patients with chronic kidney disease (CKD-group) and patients without. Odds ratios (OR) for the primary and secondary outcomes were calculated, and multivariable regression analysis was utilized to adjust for confounding variables. Results: Compared with patients without CKD, patients in CKD-group were older (mean age 67.9 vs. 60.5 years, P <0.01), had a longer mean length of stay (8.73 vs. 5.69 days, P <0.01), and higher in-hospital mortality (OR 2.24, 95% confidence interval (CI) (1.29-3.88), P<0.01). CKD-group patients had increased risk of developing acute kidney injury (10% vs. 8.6%, P<0.01) and 30-day readmission rate due to VT (OR 1.77, 95% CI (1.17-2.69), P<0.01). Conclusion: In patients with CKD, VT ablation is associated with worse clinical outcomes in-hospital mortality and 30-day readmission rate. This significantly influences the decision-making prior to performing this procedure.

National prevalence and outcomes of different mitral valve interventions for mitral regurgitation among patients with cardiogenic shock: an analysis of the national readmission database 2010–2018

Background Prevalence and outcome data of mitral valve (MV) interventions for severe mitral regurgitation (MR) in the setting of cardiogenic shock (CS) is limited. Purpose Our aim is to study the national prevalence, mortality, and outcomes of three mitral valve interventions (transcatheter mitral valve (MitraClip), surgical mitral valve repair (sMVR), and surgical mitral valve replacement (sMVr)) in patients with severe MR and CS, and how they compare to a non-invasive medical approach to management. Methods Patients with concomitant severe MR and CS were included for the years 2010 - 2018 from the national readmission database. We compared the national prevalence, in hospital mortality, readmission rate, and outcomes of patients who were treated either medically (non-invasive), or underwent an invasive approach with MitraClip, sMVR, or sMVr using one-way ANOVA and logistic regression. Results A total of 106,015 patients (68±13 years, 42% women) with severe MR and CS were identified. Of these, 88,696 (84%) were treated medically, while 607 (0.6%) underwent MitraClip, 4,528 (4%) underwent sMVR, and 12,184 (12%) underwent sMVr. Majority of patients in all four groups had a high Elixhauser comorbidity score of &gt;6. In-hospital mortality rate was 31% in the medical therapy group, 14% and 17% in the sMVR and sMVr groups subsequently, and 26% in the MitraClip group (p&lt;0.001). The median cost of hospitalization was significantly higher in the MitraClip group ($400,087) compared to the other groups (medical=$140,282, sMVR =$290,456, and sMVr =$353,688, p&lt;0.001). Readmission rates were significantly lower in the sMVR (0.7%) and sMVr (1%) groups compared to the medical therapy (4%) and MitraClip (6%) groups (p&lt;0.001). MitraClip was associated with a higher use of Impella (Odds Ratio (OR) 2.6; 95% Confidence Interval (CI) 1.8–3.8, p&lt;0.001), intra-aortic balloon pump (IABP) (OR 3.8; 95% CI 2.9–5.1, p&lt;0.001), and vasopressors (OR 1.6; 95% CI 1.1–1.7, p&lt;0.001) than sMVR or sMVr. Extracorporeal membrane oxygenation (ECMO) use was more common in sMVR (OR 2.9, 95% CI 2.5–3.4, p&lt;0.001) and sMVr (OR 2.0,95% CI 1.8–2.2, p&lt;0.001) than in MitraClip. In terms of complications, MitraClip was associated with a higher rate of vascular complications (OR 4.2; 95% CI 1.4–12.8, p&lt;0.001); while both sMVR and sMVr had higher association with significant post-operative bleeding (OR 2.3; 95% CI 1.9–2.8, p&lt;0.001) and (OR 2.1; 95% CI 1.9–2.4, p&lt;0.001) respectively. Conclusion Majority of patients in this cohort with severe MR and CS were treated either medically or underwent surgical MV replacement. Although MitraClip improved hospital mortality over medical therapy, it was associated with a higher mortality risk, readmission rate, and cost of hospitalization when compared to sMVR and sMVr. FUNDunding Acknowledgement Type of funding sources: None.

Readmissions in Patients with Cerebral Cavernous Malformations (CCMs): A National Readmission Database (NRD) Study

BACKGROUNDCerebral cavernous malformations (CCMs) are microvascular CNS lesions prone to hemorrhage leading to neurological sequela such as stroke and seizure. A subset of CCM patients have aggressive disease leading to multiple bleeding events, likely resulting multiple hospitalizations. Hospital admission rates are an important metric that has direct financial impact on hospitals and an indicator of overall disease burden. Furthermore, analysis of hospital readmissions can lead to early identification of high-risk patients and provides insight into the pathogenesis of CCM lesions. The purpose of this study is to identify high risk CCM patients with increased all cause readmission and comorbidities associated with increased readmissions.METHODSAll US hospital admissions due to CCMs were searched using the 2017 National Readmission Database (NRD). Patients with readmissions within 30 days of discharge from index hospitalization were identified and analyzed, relative to the remaining population.RESULTSAmong all patients hospitalized for CCM, 14.9% (13.7-16.2%) required all cause readmission within 30 days. Multivariate logistical regression analysis showed that substance abuse (p=0.003), diabetes (p=0.018), gastrointestinal bleed (p=0.002), renal failure (p=0.027), and coronary artery disease (p=0.010) were predictive of all cause readmissions, while age group 65-74 (p=0.042), private insurance (p<0.001), and treatment at a metropolitan teaching institution (p=0.039) were protective. Approximately half of all readmissions are caused by neurological (33.9%) and infectious (14.6%) etiologies. The 30-day lesion bleeding rate after index hospitalization is 0.8% (0.5-1.2%).CONCLUSIONSAll identified comorbidities associated with increased risks of readmission contribute to vascular stress, suggesting its role in lesion pathogenesis. This is the first and only study to analyze readmission metrics for CCMs in order to identify high risk patient factors to date.