Hospital Readmission in Patients With Spontaneous Coronary Artery Dissection

https://doi.org/10.1016/j.amjcard.2021.03.051Get rights and content

Spontaneous coronary artery dissection (SCAD) can present with various clinical symptoms, including chest pain, syncope, and sudden cardiac death, particularly in those without atherosclerotic risk factors. In this contemporary analysis, we aimed to identify the causes and predictors of 30-day hospital readmission in SCAD patients. We utilized the latest Nationwide Readmissions Database from 2016 - 2017 to identify patients with a primary discharge diagnosis of SCAD. The primary outcome was 30-day readmission. Among 795 patients admitted with a principal discharge diagnosis of SCAD, 85 (11.3%) were readmitted within 30 days of discharge from index admission (69.8% women, mean age of 54.3 ± 0.8). More than half of the readmissions (57%) were cardiac-related readmissions. Common cardiac causes for 30-day hospital readmission were acute coronary syndrome (27.3%), chest pain/unspecified angina (24.6%), heart failure (17.5%), and recurrent SCAD (8.3%). In conclusion, we found that following hospitalization for SCAD, almost one-tenth of patients were readmitted within 30 days, largely due to cardiac cause . Risk stratifying patients with SCAD, identifying high-risk features or atypical phenotypes of SCAD, and using appropriate management strategies may prevent hospital readmissions and reduce healthcare-related costs. Further studies are warranted to confirm these causes of readmission in SCAD patients.

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Methods

We queried the NRD on hospital admissions using the International Classification of Diseases, Tenth Revision (ICD-10), searching between January 2016 and December 2017. Drawing data from Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID), the NRD used verified patient linkage numbers to track entrants across hospitals within a state. The NRD contains unweighted data from about 18 million discharges each year in the United States. Weighted, it estimates approximately

Results

During study period, a total of 915 patients with a principal discharge diagnosis of SCAD were identified, and 120 of them were excluded from our study. Among the 795 patients with SCAD (mean age of 54.3 ± 0.8), 41 (5.1%) died during the index hospitalization. Eighty-five (11.3%) of the survivors were readmitted within 30 days of discharge after index admission. The majority of these patients were women (69.8%). Hypertension (59.3%), hyperlipidemia (43.7%), nicotine dependence (40.3%), obesity

Discussion

In this contemporary analysis, we evaluated the causes and predictors of 30-day readmission in patients with SCAD. There are 3 main findings in the present study. First, the male to female ratio is higher than previously reported (men to women: 30% to 70%), consistent with our previous reports. SCAD is unlikely to be related to atherosclerosis, and it is possible for SCAD to occur in males with non-conventional triggers (e.g., intense exercise, extreme emotional triggers, and illicit drug use).

Credit Author

Chayakrit Krittanawong: Conceptualization, Methods, Writing- Original draft preparation, Data curation, Software, analysis. Bing Yue.: Data curation, Software, Analysis, Writing- Original draft preparation. Dhruv Mahtta: Writing- Reviewing and Editing, Investigation. Anirudh Kumar: Writing- Reviewing and Editing. Scott Kaplin: Editing, Zhen Wang: Software, Validation. Hani Jneid: Writing- Reviewing and Editing, Deepak L. Bhatt: Supervision, Writing- Reviewing and Editing

Disclosures

The authors declare that they have no known competing financial interests or personal relations that could have appeared to influence the work reported our study. Dr. Krittanawong discloses the following relations – Member of the American College of Cardiology Solution Set Oversight Committee and the American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Performance Measures, The Lancet Digital Health (Advisory Board), European Heart Journal Digital Health (Editorial

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