Abstract 15598: Income Distribution and Readmission Rates for Acute Coronary Syndrome After PCI with Drug Eluting Stents

Abstract

Objectives One of the targets of health care quality improvement is to reduce readmission rates following percutaneous intervention (PCI).

Methods Patients (n=83,402) who received PCI with a drug eluting stent (DES) in New Jersey (NJ) between 2003 and 2009 were identified from the Myocardial Infarction Data Acquisition System database (MIDAS). Average income for each NJ zip code was obtained from the IRS Income and Tax Filing Record, grouped into quintiles (low to high, Q1-Q5), and linked to the patient zip code. Readmissions due to acute coronary syndrome (ACS) and mortality in each income quintile were assessed at 30 days and one year after discharge from their index hospitalization. Multivariate proportional hazard model adjusting for comorbidities and Cochran-Armitage trend test were used to determine the impact of income on readmission rates and mortality at 1-year.

Results The lowest income group had higher proportion of females, African Americans, Medicaid or self-pay, and more comorbidities including hypertension, diabetes, anemia, renal disease (all P <0.0001). After adjusting for demographics and co-morbidities, compared to the median income group (Q3), patients from lowest income quintile (Q1) had 14% higher risk of readmission for ACS at 1 year while patients from highest income quintile (Q5) had 13% lower risk (Table). After PCI with DES, there was a significant decreasing trend of readmissions with increasing income by trend analysis (P<0.0001). ACS readmissions at 30 days after PCI were significantly associated with increased risk of one year mortality (HR: 3.8, 95% CI: 3.1-4.5).

Conclusions This study shows that among patients with DES, income has significant influence on readmission rate for ACS and on subsequent survival. Issues related to access to care and compliance with medications need to be addressed before discharge to overcome the disparity in outcomes.