TY - JOUR
T1 - Nonspecific Chest Pain and 30-Day Unplanned Readmissions in the United States (From the Nationwide Readmission Database)
AU - Kwok, Chun Shing
AU - Parwani, Purvi J.
AU - Fischman, David L.
AU - Thamman, Ritu
AU - Suwaidi, Jassim al
AU - Mohamed, Mohamed
AU - Borovac, Josip A.
AU - Loke, Yoon K.
AU - Kontopantelis, Evangelos
AU - Brown, David L.
AU - Mamas, Mamas A.
N1 - Funding Information:
We are grateful to the Healthcare Cost and Utilization Project (HCUP) and the HCUP Data Partners for providing the data used in the analysis. List of Supports/Grants Information: The study was supported by a grant from the Research and Development Department at the Royal Stoke Hospital. This work is conducted as a part of PhD for CSK which is supported by Biosensors International. Author agreement: The authors confirm that the manuscript has not been submitted and is not under consideration for publication elsewhere. All of the authors fulfill the criteria for authorship as detailed in the instructions for authors, namely (1) conception and design or analysis and interpretation of data, (2) drafting of the manuscript and revising it critically for important intellectual content; and (3) final approval of the manuscript submitted. Finally, the authors confirm that there are no relationships with industry or financial associations that might pose a conflict of interest in connection with this submitted article.
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/4/15
Y1 - 2019/4/15
N2 - Chest pain is a common reason for admission to hospital and little is known regarding 30-day unplanned readmissions after an admission with a primary discharge diagnosis of nonspecific chest pain. We analyzed patients with a primary diagnosis of nonspecific chest pain in the Nationwide Readmission Database who were admitted in 2010 to 2014. Rates, causes, and predictors of 30-day unplanned readmissions were determined. A total of 1,842,270 patients had a diagnosis of nonspecific chest pain. The 30-day unplanned readmission rate was 8.6%. From 2010 to 2014, there was an increase in 30-day unplanned readmissions from 8.1% to 9.5%. The majority of 30-day unplanned readmissions were for noncardiac reasons (73.4%). The 3 most prevalent noncardiac causes for readmissions were neuropsychiatric (10.9%), gastrointestinal (10.5%), and infections (9.9%), while the 3 most prevalent cardiac causes were coronary artery disease including angina (8.4%), arrhythmias (6.6%), and heart failure 5.5%. The strongest predictors of readmission were alcohol misuse ([OR] odds ratio 1.74 95% [CI] confidence interval 1.66–1.81), renal failure (OR 1.82 95%CI 1.76–1.87), cancer (OR 2.40 95%CI 2.27–2.53), discharge to a nursing home (OR 2.26 95%CI 2.18–2.34), and discharge against medical advice (OR 1.94 95%CI 1.86–2.02). The rate of 30-day unplanned readmission was 6.1% among those who received any test compared to 9.3% in those who did not receive any test. Rates of early unplanned readmissions occur following 1 in 12 admissions for nonspecific chest pain with noncardiac causes being the most common reason. Patients who receive a cardiovascular investigation appear to have fewer unplanned readmissions.
AB - Chest pain is a common reason for admission to hospital and little is known regarding 30-day unplanned readmissions after an admission with a primary discharge diagnosis of nonspecific chest pain. We analyzed patients with a primary diagnosis of nonspecific chest pain in the Nationwide Readmission Database who were admitted in 2010 to 2014. Rates, causes, and predictors of 30-day unplanned readmissions were determined. A total of 1,842,270 patients had a diagnosis of nonspecific chest pain. The 30-day unplanned readmission rate was 8.6%. From 2010 to 2014, there was an increase in 30-day unplanned readmissions from 8.1% to 9.5%. The majority of 30-day unplanned readmissions were for noncardiac reasons (73.4%). The 3 most prevalent noncardiac causes for readmissions were neuropsychiatric (10.9%), gastrointestinal (10.5%), and infections (9.9%), while the 3 most prevalent cardiac causes were coronary artery disease including angina (8.4%), arrhythmias (6.6%), and heart failure 5.5%. The strongest predictors of readmission were alcohol misuse ([OR] odds ratio 1.74 95% [CI] confidence interval 1.66–1.81), renal failure (OR 1.82 95%CI 1.76–1.87), cancer (OR 2.40 95%CI 2.27–2.53), discharge to a nursing home (OR 2.26 95%CI 2.18–2.34), and discharge against medical advice (OR 1.94 95%CI 1.86–2.02). The rate of 30-day unplanned readmission was 6.1% among those who received any test compared to 9.3% in those who did not receive any test. Rates of early unplanned readmissions occur following 1 in 12 admissions for nonspecific chest pain with noncardiac causes being the most common reason. Patients who receive a cardiovascular investigation appear to have fewer unplanned readmissions.
UR - http://www.scopus.com/inward/record.url?scp=85060735629&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2019.01.012
DO - 10.1016/j.amjcard.2019.01.012
M3 - Article
C2 - 30709600
AN - SCOPUS:85060735629
VL - 123
SP - 1343
EP - 1350
JO - American Journal of Cardiology
JF - American Journal of Cardiology
SN - 0002-9149
IS - 8
ER -