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Many stent patients get rehospitalized: study

By Genevra Pittman

NEW YORK (Reuters Health) - A New York State study of 40,000 patients getting stents inserted to open up blocked arteries found that almost one in six of them were readmitted to the hospital within a month of the procedure, often for heart conditions and chest pain.

That's higher than the rehospitalization rate of one in 10 stent patients reported at a single Minnesota hospital in a study published last month (see Reuters Health story of November 28, 2011.)

Regardless of the exact number, those figures are troubling, researchers said.

"In general, all the studies have shown that readmission rates after (stent procedures) are higher than what we would expect. It points to a national problem in general regarding readmission after a hospitalization," said Dr. Adrian Hernandez, a cardiologist at the Duke University School of Medicine in Durham, North Carolina, who wasn't involved in the research.

Rehospitalizations are costly to patients and the health care system, and experts believe many may be preventable if heart patients are treated properly the first time around and sent home with the resources to keep them out of trouble.

The new study suggests that most of the factors that put patients at higher risk of readmission -- such as being older, or having more underlying diseases -- can't be changed by better care.

But researchers said that cardiologists treating those patients can be aware of their extra risks, and take special precautions to make sure that when they leave the hospital, it's for good.

Data for the new study came from just over 40,000 stent procedures done on patients in New York in 2007. Within the 30 days after they were discharged from the hospital, about 16 percent of patients were readmitted. The majority of those were unplanned return trips, while in one-fifth of the cases doctors had planned a second procedure later in the month.

Patients were most often hospitalized again for heart disease, heart failure or chest pain. One in every three readmissions resulted in a repeat of the stent procedure.

Researchers led by Edward Hannan of the University at Albany, State University of New York, found that being older or a woman, having underlying diseases like diabetes and kidney failure and having a longer original procedure or one with complications were all linked to a higher chance of being rehospitalized.

"The majority of the factors are not modifiable. For instance, you can't change someone's age, you can't change someone's gender," Hernandez told Reuters Health.

But cardiologist Dr. Joseph Cacchione from the Cleveland Clinic, who wrote a commentary published with the study in JACC: Cardiovascular Interventions, said that knowing those risk factors is important for predicting -- and preventing -- repeat hospital stays.

For patients at risk, he said, "You could keep them a little longer (or) depending on the circumstances you could have more aggressive care coordination or home care."

Keeping a patient in the hospital for an extra day the first time around is much cheaper than readmitting them, and rehospitalization often comes with more intense and expensive procedures, Cacchione told Reuters Health.

Patients are also better off, and less likely to need further hospital stays, when they go home with all of their medications and an explanation of how to take care of themselves and what warning signs to be on the lookout for, researchers said.

Talking to your doctor on the phone a few days after the stent procedure and coming in for a check-up about a week later will also help ward off any problems serious enough to require readmission, Hernandez said.

But the goal is not to eliminate all return hospital trips -- some patients will always have emergencies not related to the procedure, or complications that aren't totally preventable, which need to be treated in that setting.

"Not all readmissions are evil," Cacchione said. "Patients have to understand that occasionally the treatments that we do are not perfect and the way their bodies or them as individuals respond to them aren't perfect."

But, he said, "The majority of patients, when we send them home, shouldn't come back."

SOURCE: http://bit.ly/vqtvnA JACC: Cardiovascular Interventions, December 2011.

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