Nonspecific Chest Pain and 30-Day Unplanned Readmissions in the United States (From the Nationwide Readmission Database)

Chun Shing Kwok, Purvi J. Parwani, David L. Fischman, Ritu Thamman, Jassim al Suwaidi, Mohamed Mohamed, Josip A. Borovac, Yoon K. Loke, Evangelos Kontopantelis, David L. Brown, Mamas A. Mamas

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)1343-1350
Number of pages8
JournalAmerican Journal of Cardiology
Volume123
Issue number8
DOIs
StatePublished - Apr 15 2019

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