title: Temporal Trends in the Risk Profile of Patients Undergoing Outpatient Percutaneous Coronary Intervention: A Report from the National Cardiovascular Data Registry's CathPCI Registry.
abstract: BACKGROUND
  Because of recent changes in criteria for coverage for inpatient hospital stays, most nonacute percutaneous coronary intervention (PCI) procedures are reimbursed on an outpatient basis regardless of underlying patient risk. Downstream effects of these changes on the risk profile of patients undergoing outpatient PCI have not been evaluated.
  
  
  RESULTS
  Using the American College of Cardiology National Cardiovascular Data Registry's CathPCI Registry, we assessed temporal trends in risk profiles and rates of hospital admission among 999 279 patients undergoing PCI qualifying for outpatient reimbursement. We estimated mortality and bleeding risk using validated models from the registry. From 2009 to 2014, the proportion of outpatients not admitted to a hospital after PCI increased from 32.8% to 66.3% (P<0.001). Patients who were admitted after PCI were older, had greater comorbidities, and experienced more post-PCI complications (all P<0.001). Among those not admitted, the proportion of patients at high risk for predicted mortality increased significantly from 17.0% to 19.8% during the study period (P<0.001). In contrast, 16.7% of patients admitted after PCI were at low risk for mortality.
  
  
  CONCLUSIONS
  Among patients undergoing PCI procedures that qualify for outpatient reimbursement, there has been a temporal decrease in postprocedure hospital admission. Concomitantly, the proportion of these outpatients at high risk for mortality has significantly increased over time. These data suggest that current reimbursement classification could be improved by incorporating patient risk to appropriately match the necessary resources to the needed level of care.
authors.affiliation: From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.N.V., D.D., T.Y.W., M.T.R., M.R.P., E.D.P., S.V.R.); Department of Cardiovascular Medicine, University of Michigan, Ann Arbor (H.G.); Division of Cardiology, Washington University School of Medicine, St. Louis, MO (A.P.A.); Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.C.M.); Division of Cardiovascular Medicine, Department of Medicine, University of California-San Diego (E.M.); Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.); Harvard Clinical Research Institute, Boston, MA (L.M.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (J.C.); and University of Vermont Cardiovascular Research Institute, Burlington, VT (H.L.D.). a.vora@duke.edu.
authors.forename: Amit N
authors.initials: AN
authors.lastname: Vora
authors.affiliation: From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.N.V., D.D., T.Y.W., M.T.R., M.R.P., E.D.P., S.V.R.); Department of Cardiovascular Medicine, University of Michigan, Ann Arbor (H.G.); Division of Cardiology, Washington University School of Medicine, St. Louis, MO (A.P.A.); Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.C.M.); Division of Cardiovascular Medicine, Department of Medicine, University of California-San Diego (E.M.); Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.); Harvard Clinical Research Institute, Boston, MA (L.M.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (J.C.); and University of Vermont Cardiovascular Research Institute, Burlington, VT (H.L.D.).
authors.forename: Dadi
authors.initials: D
authors.lastname: Dai
authors.affiliation: From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.N.V., D.D., T.Y.W., M.T.R., M.R.P., E.D.P., S.V.R.); Department of Cardiovascular Medicine, University of Michigan, Ann Arbor (H.G.); Division of Cardiology, Washington University School of Medicine, St. Louis, MO (A.P.A.); Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.C.M.); Division of Cardiovascular Medicine, Department of Medicine, University of California-San Diego (E.M.); Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.); Harvard Clinical Research Institute, Boston, MA (L.M.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (J.C.); and University of Vermont Cardiovascular Research Institute, Burlington, VT (H.L.D.).
authors.forename: Hitinder
authors.initials: H
authors.lastname: Gurm
authors.affiliation: From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.N.V., D.D., T.Y.W., M.T.R., M.R.P., E.D.P., S.V.R.); Department of Cardiovascular Medicine, University of Michigan, Ann Arbor (H.G.); Division of Cardiology, Washington University School of Medicine, St. Louis, MO (A.P.A.); Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.C.M.); Division of Cardiovascular Medicine, Department of Medicine, University of California-San Diego (E.M.); Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.); Harvard Clinical Research Institute, Boston, MA (L.M.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (J.C.); and University of Vermont Cardiovascular Research Institute, Burlington, VT (H.L.D.).
authors.forename: Amit P
authors.initials: AP
authors.lastname: Amin
authors.affiliation: From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.N.V., D.D., T.Y.W., M.T.R., M.R.P., E.D.P., S.V.R.); Department of Cardiovascular Medicine, University of Michigan, Ann Arbor (H.G.); Division of Cardiology, Washington University School of Medicine, St. Louis, MO (A.P.A.); Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.C.M.); Division of Cardiovascular Medicine, Department of Medicine, University of California-San Diego (E.M.); Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.); Harvard Clinical Research Institute, Boston, MA (L.M.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (J.C.); and University of Vermont Cardiovascular Research Institute, Burlington, VT (H.L.D.).
authors.forename: John C
authors.initials: JC
authors.lastname: Messenger
authors.affiliation: From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.N.V., D.D., T.Y.W., M.T.R., M.R.P., E.D.P., S.V.R.); Department of Cardiovascular Medicine, University of Michigan, Ann Arbor (H.G.); Division of Cardiology, Washington University School of Medicine, St. Louis, MO (A.P.A.); Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.C.M.); Division of Cardiovascular Medicine, Department of Medicine, University of California-San Diego (E.M.); Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.); Harvard Clinical Research Institute, Boston, MA (L.M.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (J.C.); and University of Vermont Cardiovascular Research Institute, Burlington, VT (H.L.D.).
authors.forename: Ehtisham
authors.initials: E
authors.lastname: Mahmud
authors.affiliation: From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.N.V., D.D., T.Y.W., M.T.R., M.R.P., E.D.P., S.V.R.); Department of Cardiovascular Medicine, University of Michigan, Ann Arbor (H.G.); Division of Cardiology, Washington University School of Medicine, St. Louis, MO (A.P.A.); Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.C.M.); Division of Cardiovascular Medicine, Department of Medicine, University of California-San Diego (E.M.); Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.); Harvard Clinical Research Institute, Boston, MA (L.M.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (J.C.); and University of Vermont Cardiovascular Research Institute, Burlington, VT (H.L.D.).
authors.forename: Laura
authors.initials: L
authors.lastname: Mauri
authors.affiliation: From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.N.V., D.D., T.Y.W., M.T.R., M.R.P., E.D.P., S.V.R.); Department of Cardiovascular Medicine, University of Michigan, Ann Arbor (H.G.); Division of Cardiology, Washington University School of Medicine, St. Louis, MO (A.P.A.); Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.C.M.); Division of Cardiovascular Medicine, Department of Medicine, University of California-San Diego (E.M.); Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.); Harvard Clinical Research Institute, Boston, MA (L.M.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (J.C.); and University of Vermont Cardiovascular Research Institute, Burlington, VT (H.L.D.).
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
authors.affiliation: From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.N.V., D.D., T.Y.W., M.T.R., M.R.P., E.D.P., S.V.R.); Department of Cardiovascular Medicine, University of Michigan, Ann Arbor (H.G.); Division of Cardiology, Washington University School of Medicine, St. Louis, MO (A.P.A.); Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.C.M.); Division of Cardiovascular Medicine, Department of Medicine, University of California-San Diego (E.M.); Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.); Harvard Clinical Research Institute, Boston, MA (L.M.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (J.C.); and University of Vermont Cardiovascular Research Institute, Burlington, VT (H.L.D.).
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe
authors.affiliation: From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.N.V., D.D., T.Y.W., M.T.R., M.R.P., E.D.P., S.V.R.); Department of Cardiovascular Medicine, University of Michigan, Ann Arbor (H.G.); Division of Cardiology, Washington University School of Medicine, St. Louis, MO (A.P.A.); Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.C.M.); Division of Cardiovascular Medicine, Department of Medicine, University of California-San Diego (E.M.); Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.); Harvard Clinical Research Institute, Boston, MA (L.M.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (J.C.); and University of Vermont Cardiovascular Research Institute, Burlington, VT (H.L.D.).
authors.forename: Jeptha
authors.initials: J
authors.lastname: Curtis
authors.affiliation: From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.N.V., D.D., T.Y.W., M.T.R., M.R.P., E.D.P., S.V.R.); Department of Cardiovascular Medicine, University of Michigan, Ann Arbor (H.G.); Division of Cardiology, Washington University School of Medicine, St. Louis, MO (A.P.A.); Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.C.M.); Division of Cardiovascular Medicine, Department of Medicine, University of California-San Diego (E.M.); Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.); Harvard Clinical Research Institute, Boston, MA (L.M.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (J.C.); and University of Vermont Cardiovascular Research Institute, Burlington, VT (H.L.D.).
authors.forename: Manesh R
authors.initials: MR
authors.lastname: Patel
authors.affiliation: From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.N.V., D.D., T.Y.W., M.T.R., M.R.P., E.D.P., S.V.R.); Department of Cardiovascular Medicine, University of Michigan, Ann Arbor (H.G.); Division of Cardiology, Washington University School of Medicine, St. Louis, MO (A.P.A.); Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.C.M.); Division of Cardiovascular Medicine, Department of Medicine, University of California-San Diego (E.M.); Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.); Harvard Clinical Research Institute, Boston, MA (L.M.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (J.C.); and University of Vermont Cardiovascular Research Institute, Burlington, VT (H.L.D.).
authors.forename: Harold L
authors.initials: HL
authors.lastname: Dauerman
authors.affiliation: From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.N.V., D.D., T.Y.W., M.T.R., M.R.P., E.D.P., S.V.R.); Department of Cardiovascular Medicine, University of Michigan, Ann Arbor (H.G.); Division of Cardiology, Washington University School of Medicine, St. Louis, MO (A.P.A.); Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.C.M.); Division of Cardiovascular Medicine, Department of Medicine, University of California-San Diego (E.M.); Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.); Harvard Clinical Research Institute, Boston, MA (L.M.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (J.C.); and University of Vermont Cardiovascular Research Institute, Burlington, VT (H.L.D.).
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.N.V., D.D., T.Y.W., M.T.R., M.R.P., E.D.P., S.V.R.); Department of Cardiovascular Medicine, University of Michigan, Ann Arbor (H.G.); Division of Cardiology, Washington University School of Medicine, St. Louis, MO (A.P.A.); Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.C.M.); Division of Cardiovascular Medicine, Department of Medicine, University of California-San Diego (E.M.); Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.); Harvard Clinical Research Institute, Boston, MA (L.M.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (J.C.); and University of Vermont Cardiovascular Research Institute, Burlington, VT (H.L.D.).
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
mesh_terms: D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care / Q000639:trends*; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000639:trends; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D017064:Process Assessment, Health Care / Q000639:trends*; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: comorbidity; hospitalization; length of stay; outpatients; percutaneous coronary intervention