Abstract 4011: Preprocedural Anemia is a Significant Predictor of Hospital Cost in Percutaneous Coronary Intervention
Background: Pre-procedural anemia is associated with increased short-term and long-term morbidity and mortality in patients undergoing percutaneous coronary intervention (PCI). The incremental economic impact of pre-procedural anemia is examined.
Methods: Clinical, core angiographic, and cost data were prospectively collected on 1328 consecutive hospitalizations with PCI in 1153 patients. Variable and apportioned fixed costs were measured from an individual patient resource-use cost-accounting system. Hypothesized predictors of cost were examined.
Results: The mean pre-procedural hematocrit (Hct) was 39.0±5.4%. 27.9% of males and 25.6% of females were anemic. The mean age was 60±13 years. Females comprised 35% of the sample. Indication for PCI was acute ST-segment elevation MI in 14.7%, post-MI 18.7%, unstable angina 34.9%, stable angina 26.9%, and silent ischemia 4.3%. Diabetes was present in 36.4%, prior CABG in 12.5%, and cardiogenic shock 3.1%. In step-wise multivariate regression analysis, pre-procedural anemia was the third most powerful significant independent predictor of hospital cost including clinical, angiographic, and procedural factors. Age, gender, and renal dysfunction were not significant independent predictors of cost.
Conclusions: Pre-procedural anemia is common in patients undergoing PCI. Pre-procedural anemia is a significant independent predictor of total hospital cost in patients undergoing PCI. An incremental hospital cost of $250 was associated with each Hct point below the normal range. Strategies to improve the care of anemic patients undergoing PCI should be developed and prospectively tested.