B. C.’ s blocked heart patients back in hospital more often than normal

B. C. has the highest rate in Canada of patients rushed back to hospitals after angioplasty procedures done to open blocked heart vessels.

The average hospital readmission rate within 30 days of a percutaneous coronary intervention, commonly known as angioplasty, is 8.1 per cent. The national average for readmissions after such emergency or scheduled angioplasties is 7.4 per cent.

The hospital readmission numbers are a sharp contrast to B. C.’ s impressively low death rates after major and minor heart surgeries and has medical experts pledging to delve deep into the data to see if changes are necessary.

The data comes from a recently released report by the Canadian Institute for Health Information showing St. Paul’s Hospital in Vancouver not only has the highest risk- adjusted readmission rate after angioplasty in B. C. ( nine per cent), but the second- highest readmission rate in Canada. Readmission rates for all B. C. hospitals were higher than expected; readmission rates as low as five per cent are found in some Canadian hospitals.

Mortality and readmission rates are a measure of the quality of car- diovascular care. When they are relatively high, it is a sign patients may not be getting the best care, are being sent home from hospitals too soon, or aren’t receiving adequate post- procedure care in the hospital or once discharged.

“That readmission figure jumped out at us, too,” said Carol Laberge, a nurse and executive director of Cardiac Services B. C.

Cardiac Services B. C. plans and monitors cardiovascular care.

Laberge said biostatisticians working in the health regions are “drilling down” into the data to identify why readmission rates are higher than the national average.

“We take this seriously,” she said, noting there may have been improvements; the report covers a three- year period up to 2016.

Readmission rates can be influenced by factors such as home support, medications, and gastrointestinal bleeds caused by anti- clotting medications, she said. The report by the Canadian Institutes of Health Information and the Canadian Cardiovascular Society lists the top- five reasons for readmission after an angioplasty procedure: pain in throat and chest, heart failure, angina, heart attack and chronic ischemic heart disease.

There is a debate over what can be done about preventable hospital readmissions. In some countries, hospitals are penalized financially for high readmission rates.

A University of B. C. study in 2015 based on data from 2010 to 2013 found many B. C. hospitals had higher- than- expected readmission rates for two out of three serious conditions studied. One, Chilliwack General, had an excessive readmission rate for all three conditions — heart failure, heart attack and pneumonia. Another B. C. report last year showed obese patients have a higher risk of readmission.

When patients are rushed back to hospital, it causes bed access problems for other patients and overall higher costs, estimated to be millions of dollars a year.

No cardiac centre in Canada performed well above or below average on all measures. Data from 38 heart centres in nine provinces are included in the report, including five hospitals in B. C. with dedicated cardiac centres: Kelowna General Hospital, St. Paul’s Hospital, Royal Columbian Hospital in New Westminster, Vancouver General Hospital and Royal Jubilee in Victoria. The report provides comparative data on mortality and readmission outcomes after angioplasties, coronary artery bypass graft surgery, and aortic valve replacement surgery.

The 2017 Cardiac Care Quality Indicators Report has, up to now, been provided only to hospitals and health system managers so they can get an idea of how they stack up against other centres.

Dr. Albert Chan, regional head of interventional cardiology in Fraser Health and director of the catheterization lab at Royal Columbian Hospital, said despite being one of the busiest ( by patient volume) hospitals in the country for high- risk angioplasty and bypass surgery, it has some of the lowest 30- day in- hospital mortality rates. All B. C. hospitals performed well on mortality measures related to angioplasties and bypass surgery — lower than the national average.

Chan said survival after heart surgery is the most important outcome, but an examination of readmissions is crucial, too.

RCH had a risk- adjusted rate of readmission after angioplasty of 8.3 per cent. Royal Columbian performs the most angioplasties in B. C., the fourth- most in Canada.

“Saving lives is the most impor- tant thing, but we do have to take a deep dive into these readmission rates,” Chan said. “Maybe there are some social factors, maybe patients need more supports. We need more insights and to digest this report. Are people being rushed out of hospital too quickly?

“Because of capacity issues, we need to keep patients as short as possible to free up beds, but I don’t think there is high pressure to get patients out too quickly.”