ESC calls for European studies exploring readmissions to hospital following PCI

December 19, 2011

Sophia Antipolis -- The European Society of Cardiology (ESC) welcomes the spotlight that a US study has placed on the importance of measuring rates of rehospitalisation following percutaneous coronary intervention (PCI) procedures.

The research, published today in JACC Cardiovascular Interventions¹, represents one of the first studies to explore PCI readmissions and highlights the need for similar studies to be initiated across Europe to improve patient care.

In the study, Dr Edward Hannan and colleagues from the School of Public Health at the University of New York, recorded hospital readmissions for 40,093 patients from New York State who underwent their first PCI procedure between January 1, 2007 and November 30, 2007. The retrospective review found that a total of 15.6% (6,254) of PCI patients were readmitted within 30 days, with further analysis revealing that 20.6% (1,285) of these readmissions were "staged".

Staging refers to the situation where cardiologists treat the culprit lesion responsible for the initial admission and then plan for patients to return to the hospital at a future date for treatment of additional lesions.

"Currently we've absolutely no idea of the number of patients in Europe who need readmission to hospitals after PCI," said Prof Eric Van Belle, an ESC spokesperson from the University of Lille, France. But the US finding that 12.4 % of PCI patients need to return for unplanned readmissions (that do not involve staging), he added, was much higher than he would have predicted and highlighted the need for improvements in care.

"To allow us to both prevent readmissions by tailoring care to individual patients and produce guidelines around which patients require staging we need to gain a better handle on data in Europe."

Nevertheless, the question remains whether Europe has the infrastructure to identify patients who are likely to be readmitted to multiple hospitals.

In the US study investigators acknowledged that principle diagnoses such as "chronic ischemic heart disease", "atherosclerosis" and "chest pain" were not specific enough to determine the real reasons for admissions, leaving doubts over whether the readmission had been necessitated by a complication of the index procedure or some separate event.

"Achieving a better understanding of the reasons why patients need unplanned admissions would help cardiologists learn how to target interventions to patients at greatest risk of complications," said ESC spokesperson Prof Hans Erik Bøtker, from Aarhus University, Skejby, Denmark.

Increased knowledge would also enable hospitals to be adequately reimbursed for the care. "Payments to hospitals could be adjusted to take into account factors such as co-morbidities that are likely to require additional care to prevent repeat hospitalisation. The introduction of such systems would remove incentives for hospitals to discharge patients early," said Bøtker.

The different health care reimbursement systems used in European countries, said Van Belle, influence whether hospitals offer "staged" readmissions. In some countries hospitals are reimbursed with one fee for a fixed time period regardless of the number of individual procedures or different admissions; while in other countries a separate fee is paid for each admission. The former approach discourages use of staged procedures, while the later serves to encourage them.

Both systems, argued Van Belle, can fail to take into account the clinical needs of individual patients.

"For each patient a risk benefits analysis needs to be undertaken. For most people single procedures (where all the lesions are treated at the same time) carry less overall risks than multiple procedures.

However, in certain circumstances when a great number of lesions need to be treated staged care may be necessary to reduce excessive exposure to radiation," said Van Belle.

Clearly, he added, evidence based guidelines are needed to identify the patient groups who would benefit most from staged procedures. "We need to base our decisions on clinical evidence rather than being swayed by financial gain," said Van Belle.

1. E. L. Hannan, Y Zhong, H Krumholz et al. 30-Day Readmission for Patients Undergoing Percutaneous Coronary Interventions in New York State. J Am Coll Cardiol Int December 2011, 4:1335-42

European Society of Cardiology

Related Percutaneous Coronary Intervention Articles from Brightsurf:

A bypass route for the coronary vessels in the heart?
When the heart develops, some of its coronary blood vessels develop from cells lining the inner surface of the heart's ventricular chambers (endocardium).

Amgen announces new FOURIER analysis showing Repatha® (evolocumab) reduced cardiovascular events in patients with prior percutaneous intervention at AHA 2020
Amgen (NASDAQ:AMGN) today announced a new analysis from the Repatha® (evolocumab) cardiovascular (CV) outcomes study (FOURIER) that evaluated the effectiveness of Repatha in atherosclerotic cardiovascular disease (ASCVD) patients on statin therapy with prior percutaneous coronary intervention (PCI), also known as coronary angioplasty.

Ultrasound-guided percutaneous needle biopsy excellent for small pleural lesions diagnosis
According to an open-access article in ARRS' American Journal of Roentgenology, ultrasound (US)-guided percutaneous pleural needle biopsy (PCPNB) has excellent diagnostic accuracy for small pleural lesions.

For toddlers with autism, more intervention hours are not necessarily better
Two prominent early intervention models for toddlers with autism show a very similar impact, whether delivered at 15-hours or 25-hours per week intensities, a UC Davis MIND Institute study has found.

Minimally invasive percutaneous treatment for osteoid osteoma of the spine
Osteoid osteomas are benign but painful bone-forming tumors usually involving long bones, with localization at the spine in 10-20% of the cases.

SCAI issues position statement on the performance of percutaneous coronary intervention in ambulatory surgical centers
The Society for Cardiovascular Angiography and Interventions (SCAI) today issued a position statement on the performance of percutaneous coronary intervention (PCI) in ambulatory surgical centers (ASCs).

SCAI releases official position statement on optimal percutaneous interventional therapy for complex coronary artery disease
The Society for Cardiovascular Angiography and Interventions (SCAI) has published a position statement addressing optimal percutaneous coronary intervention (PCI) treatment of patients with complex coronary artery disease (CAD).

Does coronary microvascular spasm exist?
In a new publication from Cardiovascular Innovations and Applications; Fabian Guenther, Andreas Seitz, Valeria Martínez Pereyra, Raffi Bekeredjian, Udo Sechtem and Peter Ong from the Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany consider whether coronary microvascular spasm exists.

Impact of postdilation on intervention success and MACE
In a new publication from Cardiovascular Innovations and Applications; DOI, the authors consider the impact of postdilation on intervention success and long-term major adverse cardiovascular events (MACE) among patients with acute coronary syndromes.

The relationship between mean platelet volume and in-hospital mortality in geriatric patients with ST segment elevation myocardial infarction who underwent primary percutaneous coronary intervention
In the current issue of Cardiovascular Innovations and Applications volume 4, issue 2, pp.

Read More: Percutaneous Coronary Intervention News and Percutaneous Coronary Intervention Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to