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.
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.
Halon
David A
DA
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
Rennert
Hedy S
HS
Flugelman
Moshe Y
MY
Jaffe
Ronen
R
Lewis
Basil S
BS
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