Elsevier

The American Journal of Cardiology

Volume 183, 15 November 2022, Pages 105-108
The American Journal of Cardiology

Outcomes and Readmission in Patients With Retinal Artery Occlusion (from the Nationwide Readmission Database)

https://doi.org/10.1016/j.amjcard.2022.07.040Get rights and content

Retinal artery occlusion (RAO) is an ophthalmologic emergency, leading to sudden vision loss. Understanding its risk factors and garnering information on the incidence of adverse events can provide helpful information on the cost-effective evaluation of patients and secondary prevention. In this retrospective cohort study, we used the Nationwide Readmission Database from 2016 to 2018 and queried the database to identify patients with RAO. The clinical outcomes were cumulative incidence of myocardial infarction (MI), stroke, death (in-hospital and 6 months after discharge), resource utilization, all-cause readmission at 6 months, and reasons for all-cause readmission. We identified a total of 14,527 patients with RAO. The mean age of patients with RAO was 69 ± 13 years. Hypertension (11,839, 82%), hyperlipidemia (8,868, 61%), ischemic cardiomyopathy (4,826, 33%), smoking (4,772, 33%), and diabetes (4,588, 32%) were common co-morbidities in patients with RAO. Of 14,527 patients with RAO, 308 patients (2.1%) died, 1,577 (10.9%) developed stroke, and 615 (4.2%) developed MI within 6 months. A total of 2,841 patients (24.9%) were readmitted within 6 months of discharge. Carotid artery stenosis (386, 10.8%) was the most common cause of readmission. History of stroke or transient ischemic attack and Elixhauser co-morbidity index ≥3 were predictors of stroke. Female gender, ischemic cardiomyopathy, carotid artery disease, heart failure, chronic kidney disease, and cancer were predictors of MI. Cancer, chronic kidney disease, Elixhauser co-morbidity index ≥3, Medicare/Medicaid payer status, nonelective index admission, atrial fibrillation, and carotid artery disease were predictors of 6-month all-cause readmission. In conclusion, patients with RAO have a significant burden of co-morbidities, death, stroke, MI, and readmission. RAO may be used as a clinical marker of future stroke and MI, and should trigger screening for acute vascular ischemic events.

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Methods

The study cohort was derived using the Nationwide Readmission Database (NRD) from 2016 to 2018. The NRD is part of the Healthcare Cost and Utilization Project's family of databases by the Agency for Healthcare Research and Quality. This study was exempt from review by the Cleveland Clinic Institutional Review Board in accordance with the institutional policy. We queried the database using the International Classification of Diseases, Tenth Revision (ICD-10) diagnostic codes H34.0, H43.1,

Results

This study included a total of 14,527 patients with RAO. The mean age of patients admitted with RAO was 69 ± 13 years (Table 1); 7,532 patients (52%) were men. Most common co-morbidities were hypertension in 11,839 patients (82%), hyperlipidemia in 8,868 patients (61%), ischemic cardiomyopathy in 4,862 patients (33%), smoking in 4,772 patients (33%), and diabetes in 4,588 patients (32%). Other important co-morbidities included carotid artery disease (3,863 [27%]), peripheral vascular disease

Discussion

We report hypertension, hyperlipidemia, ischemic cardiomyopathy, smoking, and diabetes as the most common co-morbidities/risk factors among patients with RAO. Among patients with RAO, 2.1% died, 10.9% developed stroke, 4.2% developed MI, 10.5% underwent carotid procedure, and 24.9% were readmitted within 6 months. Carotid artery disease was the most common cause of readmission. In RAO, cancer, CKD, Medicare/Medicaid, and Elixhauser co-morbidity index ≥3 were strong predictors of 6-month

Disclosures

Dr. Kalra is the Chief Executive Officer and Creative Director of makeadent.org. The remaining authors have no conflicts of interest to declare.

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Funding: makeadent.org Ram and Sanjita Kalra Aavishqaar Fund.

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