Publications

Failure to achieve euvolemia before discharge in patients admitted with acute heart failure (HF) syndromes has gained attention as a marker for increased readmission risk. This study assessed whether variations in discharge documentation practices reflected the readmission risk of patients admitted for decompensated HF. This was a retrospective cohort study of 100 adult patients discharged from an admission for an acute HF syndrome from May 2014 to June 2015. Characteristics at discharge were retrieved from the discharge summaries (DS). Coprimary outcomes were 30-day and 6-month composites of all-cause readmissions or emergency department visits. Mean age was 62.1 years (SD 15.3), and 56% were men. Traditional cardiovascular risk factors were common. All-cause 30-day readmission occurred in 18%, and HF-related 30-day readmission occurred in 12% of the population. A DS physical exam in support of decongestion occurred more often in those not readmitted, for example, a normal jugular venous pulse (53.2 vs 12.5%, p = 0.03). Discussion of jugular venous pulse improvement occurred more frequently in those not readmitted (8.5 vs 0%, p = 0.03). No other markers of volume status reached statistical significance. A clear statement in the DS supporting euvolemia was uncommon, but tended to occur more commonly in those not readmitted (20.7 vs 5.6%, p = 0.13). In conclusion, documenting markers of euvolemia and incorporating these markers into the DS volume status assessment was associated with a reduced rate of 30-day readmission.

BACKGROUND

High-intensity statins (HIS) are recommended for secondary prevention following percutaneous coronary intervention (PCI). We aimed to describe temporal trends and determinants of HIS prescriptions after PCI in a usual-care setting.

METHODS

All patients with age ≤75 years undergoing PCI between January 2011 and May 2016 at an urban, tertiary care center and discharged with available statin dosage data were included. HIS were defined as atorvastatin 40 or 80 mg, rosuvastatin 20 or 40 mg, and simvastatin 80 mg.

RESULTS

A total of 10,495 consecutive patients were included. Prevalence of HIS prescriptions nearly doubled from 36.6% in 2011 to 60.9% in 2016 (P < .001), with a stepwise increase each year after 2013. Predictors of HIS prescriptions included ST-segment elevation myocardial infarction/non-ST-segment elevation myocardial infarction (odds ratio [OR] 4.60, 95% CI 3.98-5.32, P < .001) and unstable angina (OR 1.31, 95% CI 1.19-1.45, P < .001) as index event, prior myocardial infarction (OR 1.48, 95% CI 1.34-1.65, P < .001), and co-prescription of β-blocker (OR 1.26, 95% CI 1.12-1.43, P < .001). Conversely, statin treatment at baseline (OR 0.86, 95% CI 0.77-0.96, P = .006), Asian races (OR 0.73, 95% CI 0.65-0.83, P < .001), and older age (OR 0.90, 95% CI 0.88-0.92, P < .001) were associated with reduced HIS prescriptions. There was no significant association between HIS prescriptions and 1-year rates of death, myocardial infarction, or target-vessel revascularization (adjusted hazard ratio 0.98, 95% CI 0.84-1.15, P = .84), although there was a trend toward reduced mortality (adjusted hazard ratio 0.71, 95% CI 0.50-1.00, P = .05).

CONCLUSION

Although the rate of HIS prescriptions after PCI has increased in recent years, important heterogeneity remains and should be addressed to improve practices in patients undergoing PCI.