Elsevier

The American Journal of Medicine

Volume 133, Issue 12, December 2020, Pages 1453-1459.e1
The American Journal of Medicine

Clinical Research Study
Rate, Causes, and Predictors of 30-Day Readmission Following Hospitalization for Acute Pericarditis

https://doi.org/10.1016/j.amjmed.2020.05.027Get rights and content

Abstract

Background

Acute pericarditis is a frequent cause of hospitalization in the United States. Although recurrence of this condition is common, few studies have investigated hospital readmissions in this patient population.

Methods

We queried the National Readmission Database for the years 2016 and 2017 to identify adult admissions for acute pericarditis, and analyzed the data for 30-day readmission. Using multivariate Cox regression analysis, we identified clinical characteristics that were independently predictive of hospital readmission within 30 days.

Results

A total of 21,335 patients (mean age 52.5 ± 0.2 years; 38.3% women) who were discharged following hospitalization for acute pericarditis were included. The rate of 30-day readmission was 12.9% (n = 2740). Increasing age (adjusted hazard ratio [HR] 1.05 per 5-year increase; 95% confidence interval [CI], 1.02-1.09; P < 0.001), female sex (adjusted HR 1.33; 95% CI, 1.18-1.49; P < 0.001), dialysis dependence (adjusted HR 1.70; 95% CI, 1.30-2.22; P < 0.001), chronic obstructive pulmonary disease (adjusted HR 1.27; 95% CI, 1.11–1.45; P < 0.001), and presence of pericardial effusion (adjusted HR 1.24; 95% CI, 1.04-1.49; P = 0.02) were independently associated with a higher risk of readmission. In-hospital mortality was significantly higher after readmission than for the index hospitalization (3.4% vs 1.0%, P < 0.001).

Conclusion

After hospitalization for acute pericarditis, readmission within 30 days is common and is associated with increased mortality. Identification of characteristics associated with a higher risk of readmission may lead to focused interventions to improve outcomes.

Introduction

Acute pericarditis accounts for 5% of emergency department visits for chest pain in North America.1 Although mortality associated with acute pericarditis is low, patients are often hospitalized for initial management.2,3 Incessant and recurrent pericarditis are the most common complications of acute pericarditis.1,4 Although the pathophysiology of these conditions is not completely understood,1 prospective studies have reported recurrence in up to 30% of patients over 18 months after an episode of acute pericarditis.5 Despite this, studies examining rehospitalizations after acute pericarditis are very limited.1,3 Accordingly, we examined the readmissions within 30 days after an episode of acute pericarditis in the United States to determine the rate, predictors, and outcomes of this untoward complication.

Section snippets

Methods

We analyzed the National Readmission Database (NRD) maintained by the Healthcare Cost and Utilization Project (HCUP) for the years 2016 and 2017. The NRD contains stratified weighted data from 20% of all non-federal acute care hospitals in the United States, allowing for the creation of national estimates of inpatient hospitalizations and subsequent readmissions. NRD tracks each admission for subsequent readmissions during the calendar year by using a unique patient linkage number specific to

Study Population and Initial Hospitalization

We identified a total of 21,335 patients who were discharged following a hospitalization for acute pericarditis in the United States in the years 2016-2017 (Figure 1). Baseline characteristics are presented according to readmission status in Table 1. The mean age of the study cohort was 52.5 ± 0.2 years, and 38.3% of the patients were women. Women had a significantly higher prevalence of autoimmune diseases compared with men (7.6% vs 1.4, P < 0.001) among our study population. The etiology of

Discussion

In this study, we report certain key findings about readmission following hospitalization for acute pericarditis: 1) the rate of readmission at 30 days was substantial at 12.9%; 2) the single most common cause for readmission was pericardial disease; 3) older age, female sex, dialysis dependence, COPD, and the presence of a pericardial effusion during the index hospitalization identified patients at higher risk of readmission within 30 days; 4) 30-day readmission mortality was more than

Conclusion

Readmission within 30 days of hospitalization for acute pericarditis is common, and is associated with significant morbidity, mortality, and health care costs. Older age, female sex, dialysis dependence, COPD, and the presence of pericardial effusion during the index hospitalization are independently predictive of a higher risk of readmission. Once readmitted, patients with renal or pulmonary comorbidities are at a higher risk for mortality. Further research aimed at improving outcomes in

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Funding: None.

Conflict of Interest: None.

Authorship: JS: Conceptualization, validation, formal analysis, data curation, writing—original draft, writing—review and editing; MSK: Conceptualization, writing—original draft, resources; UH: Validation, formal analysis, data curation, visualization; SUK: Writing—review and editing, resources, formal analysis; WSA: Validation, writing—review and editing; FM: Writing—review and editing; RAK: Conceptualization, writing—review and editing; HAC: Conceptualization, writing—review and editing; EDM: Writing—review and editing, supervision; JAP: Conceptualization, writing—review and editing, supervision.

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