Predictors of Chest Pain Readmissions at an Academic and Community Hospital: Can Cardiology Consultation Reduce Readmissions?

Background:
Chest pain is a common emergency room presentation and a frequent cause of readmissions. Hospital readmissions are costly and associated with worse quality of life. This study aims to identify clinical and demographic predictors for readmission for non-acute coronary syndrome (ACS) chest pain after index evaluation at an academic hospital versus a community hospital, and whether cardiology consultation decreases readmissions.

Methods:
We conducted a retrospective review of 3,776 consecutive adult patients presenting with chest pain to an academic center and an affiliated community hospital in 2016. Rates and predictors of 1-year readmission were evaluated. Patients presenting with ACS or decompensated heart failure (HF) were excluded. A negative binomial regression model was used to analyze factors related to readmission.

Results:
Mean age was 47.3 years with a female predominance. The overall readmission rate was 6.3%. The following factors were associated with higher odds of readmission: prior coronary artery disease (CAD), peripheral arterial disease (PAD), hypertension (HTN), and chronic HF (table 1). Cardiology consultation was associated with reduced readmission rates in diabetics and non-white race patients. Otherwise, patients with a cardiology consultation were more likely to be readmitted. Patients with index presentation to a community hospital, versus an academic center, had lower readmission odds.

Conclusions:
Clinical variables and location of index admission were predictive of chest pain readmission. Cardiology consultation may not reduce readmissions rates.