Vascular disease

Call to action on PAD preventable readmissions

Peripheral arterial disease (PAD) patients could benefit from more intensive care during and after hospitalisation, Australian clinicians say after finding up to 10% unexpectedly return to hospital within 30 days of discharge — mostly for potentially avoidable reasons.

Their study of 104,979 PAD-related hospital admissions showed 9,765 were followed by at least one unplanned readmission within 30 days of discharge — 3,395 within a week — primarily for atherosclerosis, type 2 diabetes or procedural complications ‘not elsewhere classified’.

Patients acutely hospitalised for PAD were twice as likely to be readmitted versus elective cases, though the groups had similar time to and reasons for readmission.

Surgical intervention during PAD hospitalisation and chronic limb-threatening ischaemia were also associated with a greater likelihood of readmission (respective odds ratios: 1.74 and 1.55), Central Adelaide Local Health Network Vascular Surgeon Professor Robert Fitridge and Prince Charles Hospital Senior Staff Specialist Cardiologist Associate Professor Isuru Ranasinghe and their colleagues wrote in the Medical Journal of Australia.

Many of these readmissions could potentially have been prevented with tweaked post-operative care, they suggested.

For example, the higher readmission rate of patients with cardiac conditions such as heart failure, myocardial infarction, angina or stroke; surgical intervention versus endovascular revascularisation during PAD hospitalisation; or chronic limb-threatening ischaemia could reflect an increased risk of cardiovascular events, infection and debridement-need. Thus, these patients may “require more intensive care during and after hospitalisation”, they wrote.

This care may include improved decision making during PAD hospitalisation, aggressive primary and secondary cardiovascular disease prevention, early and routine follow-up, and targeted interventions that stave off infections such as cellulitis, pneumonia and sepsis, the authors suggested.

“An American study found that readmissions within seven days of discharge were often associated with premature discharge or incorrect decision making during the PAD hospitalisation, and that multidisciplinary follow-up and continuity of care were crucial for averting unplanned readmissions eight to 30 days after discharge,” they noted.

Improving glycaemic control may also improve outcomes for type 2 diabetes patients, who were rehospitalised 10.8% of the time.

Private hospital-care was associated with lower readmission risk, though further research is needed to determine why.

“Finally, improving discharge and hospital‐to‐homecare transition practices, supported by general practice liaison officers, has been reported to reduce readmission and emergency department visit rates by 30%, and accompanied by substantial cost savings”, they wrote.

Better care is needed to reduce the unplanned remission rate, minimise healthcare costs and improve clinical outcomes for PAD patients, they concluded.

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