title: Burden of late repeat hospitalization in patients undergoing angioplasty or bypass surgery. A long-term (13 years) report from the Lady Davis Carmel Medical Center registry.
abstract: We investigated the incidence and determinants of early and late repeat hospitalization for cardiac causes in 378 patients following myocardial revascularization [199 coronary balloon angioplasty (PTCA), 179 coronary bypass surgery (CABG)] in a single cardiovascular center and followed for a median period of 13 years. Data were available for repeat rehospitalization in 91% and for mortality in all. Patients in the upper quartile for repeat hospitalization (>or=4 rehospitalizations) were defined as having multiple repeat hospitalizations. In the PTCA cohort, the rehospitalization rate was high (48%) in the first year, partly due to restenosis and to a group of patients who underwent planned repeat angiography, and then 15-26% annually. In the surgical cohort, annual repeat hospitalization was 8-12% during the first 4 years, but increased to a level similar to that in PTCA patients (19-26%) in the second half of the follow-up period. Independent predictors of multiple (>or=4) repeat hospitalizations included systemic hypertension (odds ratio 2.4, 95% CI 1.4-4.0), incomplete revascularization (odds ratio 2.0, 95% CI 1.1-3.4) and less extensive (<3 vessels) disease at the time of the index procedure (odds ratio 2.0, 95% CI 1.1-3.4). Predictors of repeat hospitalization were different from those of mortality (diabetes mellitus, 3-vessel disease). Late repeat hospitalizations after myocardial revascularization impose a considerable burden on the patient and the health care system, and represent an issue which should be better addressed.
authors.affiliation: Department of Cardiology, Cardiovascular Research Unit, Lady Davis Carmel Medical Center and the Bruce Rappaport School of Medicine, Technion-IIT, Haifa, Israel. halon@clalit.org.il
authors.forename: David A
authors.initials: DA
authors.lastname: Halon
authors.forename: Hedy S
authors.initials: HS
authors.lastname: Rennert
authors.forename: Moshe Y
authors.initials: MY
authors.lastname: Flugelman
authors.forename: Ronen
authors.initials: R
authors.lastname: Jaffe
authors.forename: Basil S
authors.initials: BS
authors.lastname: Lewis
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D010359:Patient Readmission; D011237:Predictive Value of Tests; D012307:Risk Factors; D012737:Sex Factors; D013995:Time; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology