Of the 19 total variables associated with the risk of 30-day readmission, 14 variables were included to identify high and low risk of 30-day readmission with a point system ranging from one to six. “Due to the challenge of quickly estimating risk […] based on 14 variables,” the authors suggest that the “risk score may be a candidate for future calculator app development.”

Upon applying the risk model to the study population, the researchers found that 15 percent of PCI patients scored ≥13 and 42 percent scored ≤6. Those who scored higher had a risk of 30-day readmission greater than 18 percent, whereas those with a lower score had a less than eight percent risk of 30-day readmission.

“The employment of this risk score in the clinical setting may translate to improved patient outcomes, proper quality assessment, and guided resource management, specifically for those patients at highest risk of readmissions,” write the authors. “Future research is needed to identify intervention strategies to reduce readmission rates, as well as identify the broader nonclinical factors that may be related to risk of 30-day readmission, such as access to and coordination of care, social support, and hospital culture and organizational behavior.”

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Researchers looked at data between Oct. 1, 2010 and April 30, 2013, and found that 41.1 percent of the 273,328 MI patients identified would have met the eligibility criteria for the trial. Results showed that among the 83,871 eligible patients with pharmacy claims data, only 27.5 percent were on a P2Y12 inhibitor one year post MI, however usage declined at two and three years post MI (11.5 percent and 6.3 percent, respectively), with the majority (79.2 percent) of these patients on clopidogrel.

Additionally, cost varied greatly by P2Y12 inhibitor type; the estimated cost per ischemic event averted using long-term ticagrelor was found to be 45 times more than the generic clopidogrel ($885,000 vs. $19,800). Therefore, if the PEGASUS strategy was adopted in clinical practice, cost would likely influence the type of therapy used, the authors explain.

The authors conclude that “applying PEGASUS trial findings to clinical practice would result in a large increase in P2Y12 inhibitor use. Given the cost implications for different P2Y12 inhibitors, additional study of long-term P2Y12 inhibitors on patient outcomes and cost of care is needed to guide optimal use of this therapy in clinical practice.”

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