Health Disparities Gender Differences in the Rate of 30-Day Readmissions after Percutaneous Coronary Intervention for Acute Coronary Syndrome

Background: It has been reported that women have higher 30-day rea dmission rates than men after acute coronary syndrome (ACS). However, readmission after percutaneous coronary intervention (PCI) for ACS is a distinct subset of patients in whom gender differences have not been adequately studied. Methods: Hawaii statewide hospitalization data from 2010 to 2015 were assessed to compare gender differences in 30-day readmission rates among patients hospitalized with ACS who underwent PCI during the index hospitalization. Readmission diagnoses were categorized using an aggregated version of the Centers for Medicare and Medicaid Services Condition Categories. Multivariable logistic regression was applied to evaluate the effect of gender on the 30-day readmission rate. Results: A total of 5,354 patients (29.4% women) who were hospitalized with a diagnosis of ACS and underwent PCI were studied. Overall, women were older, with more identified as Native Hawaiian, and had a higher prevalence of cardiovascular risk factors compared with men. The 30-day readmission rate was 13.9% in women and 9.6% in men (p < .0001). In the multivariable model, female gender (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.09–1.60), Medicaid (OR, 1.48; 95% CI, 1.07–2.06), Medicare (1.72; 95% CI, 1.35–2.19), heart failure (1.88; 95% CI, 1.53–2.33), atrial fibrillation (OR, 1.54; 95% CI–1.21–1.95), substance use (OR, 1.88; 95% CI, 1.27–2.77), history of gastrointestinal bleeding (OR, 2.43; 95% CI, 1.29–4.58), and chronic kidney disease (OR, 1.78; 95% CI, 1.42–2.22) were independent predictors of 30-day readmissions. Readmission rates were highest during days 1 through 6 (peak, day 3) after discharge. The top three cardiac causes of readmissions were heart failure, recurrent angina, and recurrent ACS. Conclusions: Female gender is an independent predictor of 30-day readmission after ACS that requires PCI. Our finding suggests women are at a higher risk of post-ACS cardiac events such as heart failure and recurrent ACS, and further gender-specific intervention is needed to reduce 30-day readmission rate in women after ACS. 2018 Jacobs Institute of Women's Health. Published by Elsevier Inc. Conflict of Interest/Disclosure: None. Sources of Funding: The research described was supported by National Institute on Minority Health and Health Disparities (NIMHD) Grant P20 MD000173, U54MD00760131, and was also supported in part by NIMHD grant U54MD007584 and National Institute of General Medical Sciences (NIGMS) grants GM103341 and GM113134, and grant RO1HS019990 from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. * Correspondence to: Luke Lam, MD, The Queen’s Medical Center, 1301 Punchbowl Street, Pauahi 3rd floor, Queen’s Heart, Honolulu, HI 96813. Phone: (808) 691-4111; fax: (808) 691-5015. E-mail address: lukel@hawaii.edu (L. Lam). 1049-3867/$ see front matter 2018 Jacobs Institute of Women's Health. Publishe https://doi.org/10.1016/j.whi. 2018.09. 002 Reducing early hospital readmissions is considered an important goal for health care systems, as readmission rate is often proposed as a marker for quality of care (Ashton, Del Junco, Souchek, Wray, & Mansyur, 1997; Ashton, Kuykendall, Johnson, Wray, & Wu, 1995; Ashton & Wray, 1996; Jencks, 2010). Acute coronary syndrome (ACS) is a crucial target in this effort because it affects approximately 625,000 people each year in the United States, of whom an estimated 363,000 are men and 262,000 are women (Benjamin et al., 2017; Berger et al., 2009). ACS patients