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Non-specific Chest Pain and 30-day Unplanned Readmissions in the United States: (From the Nationwide Readmission Database)

Mamas

Authors



Abstract

Chest pain is a common reason for admission to hospital and little is known regarding 30 day unplanned readmissions after an admission with a primary discharge diagnosis of nonspecific chest pain. We analyzed patients with a primary diagnosis of nonspecific chest pain in the Nationwide Readmission Database who were admitted in 2010 to 2014. Rates, causes, and predictors of 30-day unplanned readmissions were determined. A total of 1,842,270 patients had a diagnosis of nonspecific chest pain. The 30-day unplanned readmission rate was 8.6%. From 2010 to 2014, there was an increase in 30-day unplanned readmissions from 8.1% to 9.5%. The majority of 30-day unplanned readmissions were for noncardiac reasons (73.4%). The 3 most prevalent noncardiac causes for readmissions were neuropsychiatric (10.9%), gastrointestinal (10.5%), and infections (9.9%), while the 3 most prevalent cardiac causes were coronary artery disease including angina (8.4%), arrhythmias (6.6%), and heart failure 5.5%. The strongest predictors of readmission were alcohol misuse ([OR] odds ratio 1.74 95% [CI] confidence interval 1.66-1.81), renal failure (OR 1.82 95%CI 1.76-1.87), cancer (OR 2.40 95 % CI 2.27-2.53), discharge to a nursing home (OR 2.26 95% CI 2.18-2.34), and discharge against medical advice (OR 1.94 95%CI 1.86-2.02). The rate of 30-day unplanned readmission was 6.1% among those who received any test compared to 9.3% in those who did not receive any test. Rates of early unplanned readmissions occur following 1 in 12 admissions for nonspecific chest pain with noncardiac causes being the most common reason. Patients who receive a cardiovascular investigation appear to have fewer unplanned readmissions.

Acceptance Date Jan 14, 2019
Publication Date Apr 15, 2019
Publicly Available Date Mar 28, 2024
Journal American Journal of Cardiology
Print ISSN 0002-9149
Publisher Elsevier
Pages 1343-1350
DOI https://doi.org/10.1016/j.amjcard.2019.01.012
Keywords chest pain, non-cardiac chest pain
Publisher URL https://doi.org/10.1016/j.amjcard.2019.01.012