Care Transitions after Acute Myocardial Infarction for Transferred-In Versus Direct-Arrival Patients

Amit N. Vora, Eric D. Peterson, Anne S. Hellkamp, Nadia R. Sutton, Edward Panacek, Laine Thomas, James A de Lemos, Tracy Y. Wang

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background-Many patients in the United States require transfer from one hospital to another for acute myocardial infarction (MI) care. How well these transferred-in patients are transitioned back to their local community is unknown. Methods and Results-We used linked Medicare claims data to examine postdischarge outcomes of 39 136 patients with acute MI aged ≥65 years discharged alive from 451 US hospitals in Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines. Multivariable Cox modeling was used to compare the likelihood of outpatient clinic follow-up and risks of all-cause mortality and all-cause or cardiovascular readmission at 30 days post MI between transferred-in and direct-arrival patients. From 2007 to 2010, 14 060 of 39 136 patients (36%) required interhospital transfer for acute MI care, traveling a median of 43 miles (interquartile range, 27-68 miles; 77.6 km [interquartile range, 48.2-122.6 km]). Compared with those arriving directly, transferred-in patients with MI were slightly younger (median age, 73 versus 74; Pall-cause, 1.08; 95% confidence interval, 1.01-1.15 and 9.5% versus 9.1%; HRcardiovascular, 1.13; 95% confidence interval, 1.04-1.22). In contrast, risk-adjusted 30-day mortality was similar between transferred-in and direct arrivals (1.6% versus 1.6%; HR, 1.05; 95% confidence interval, 0.86-1.27). Conclusions-Transferred-in patients with acute MI are less likely to have outpatient clinic follow-up within 30 days and more likely to be readmitted within the first 30 days post discharge compared with direct-arrival patients. These results indicate room for improvement in the safe and seamless transition of care for transferred patients with MI traveling back to their home environments.

Original languageEnglish (US)
Pages (from-to)109-116
Number of pages8
JournalCirculation: Cardiovascular Quality and Outcomes
Volume9
Issue number2
DOIs
StatePublished - Mar 1 2016

Fingerprint

Patient Transfer
Myocardial Infarction
Confidence Intervals
Ambulatory Care Facilities
Mortality
Medicare
Registries
Guidelines

Keywords

  • health services accessibility
  • myocardial infarction
  • patient readmission
  • patient transfer
  • point-of-care systems

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Vora, A. N., Peterson, E. D., Hellkamp, A. S., Sutton, N. R., Panacek, E., Thomas, L., ... Wang, T. Y. (2016). Care Transitions after Acute Myocardial Infarction for Transferred-In Versus Direct-Arrival Patients. Circulation: Cardiovascular Quality and Outcomes, 9(2), 109-116. https://doi.org/10.1161/CIRCOUTCOMES.115.002108

Care Transitions after Acute Myocardial Infarction for Transferred-In Versus Direct-Arrival Patients. / Vora, Amit N.; Peterson, Eric D.; Hellkamp, Anne S.; Sutton, Nadia R.; Panacek, Edward; Thomas, Laine; de Lemos, James A; Wang, Tracy Y.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 9, No. 2, 01.03.2016, p. 109-116.

Research output: Contribution to journalArticle

Vora, Amit N. ; Peterson, Eric D. ; Hellkamp, Anne S. ; Sutton, Nadia R. ; Panacek, Edward ; Thomas, Laine ; de Lemos, James A ; Wang, Tracy Y. / Care Transitions after Acute Myocardial Infarction for Transferred-In Versus Direct-Arrival Patients. In: Circulation: Cardiovascular Quality and Outcomes. 2016 ; Vol. 9, No. 2. pp. 109-116.
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abstract = "Background-Many patients in the United States require transfer from one hospital to another for acute myocardial infarction (MI) care. How well these transferred-in patients are transitioned back to their local community is unknown. Methods and Results-We used linked Medicare claims data to examine postdischarge outcomes of 39 136 patients with acute MI aged ≥65 years discharged alive from 451 US hospitals in Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines. Multivariable Cox modeling was used to compare the likelihood of outpatient clinic follow-up and risks of all-cause mortality and all-cause or cardiovascular readmission at 30 days post MI between transferred-in and direct-arrival patients. From 2007 to 2010, 14 060 of 39 136 patients (36{\%}) required interhospital transfer for acute MI care, traveling a median of 43 miles (interquartile range, 27-68 miles; 77.6 km [interquartile range, 48.2-122.6 km]). Compared with those arriving directly, transferred-in patients with MI were slightly younger (median age, 73 versus 74; Pall-cause, 1.08; 95{\%} confidence interval, 1.01-1.15 and 9.5{\%} versus 9.1{\%}; HRcardiovascular, 1.13; 95{\%} confidence interval, 1.04-1.22). In contrast, risk-adjusted 30-day mortality was similar between transferred-in and direct arrivals (1.6{\%} versus 1.6{\%}; HR, 1.05; 95{\%} confidence interval, 0.86-1.27). Conclusions-Transferred-in patients with acute MI are less likely to have outpatient clinic follow-up within 30 days and more likely to be readmitted within the first 30 days post discharge compared with direct-arrival patients. These results indicate room for improvement in the safe and seamless transition of care for transferred patients with MI traveling back to their home environments.",
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AU - Sutton, Nadia R.

AU - Panacek, Edward

AU - Thomas, Laine

AU - de Lemos, James A

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AB - Background-Many patients in the United States require transfer from one hospital to another for acute myocardial infarction (MI) care. How well these transferred-in patients are transitioned back to their local community is unknown. Methods and Results-We used linked Medicare claims data to examine postdischarge outcomes of 39 136 patients with acute MI aged ≥65 years discharged alive from 451 US hospitals in Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines. Multivariable Cox modeling was used to compare the likelihood of outpatient clinic follow-up and risks of all-cause mortality and all-cause or cardiovascular readmission at 30 days post MI between transferred-in and direct-arrival patients. From 2007 to 2010, 14 060 of 39 136 patients (36%) required interhospital transfer for acute MI care, traveling a median of 43 miles (interquartile range, 27-68 miles; 77.6 km [interquartile range, 48.2-122.6 km]). Compared with those arriving directly, transferred-in patients with MI were slightly younger (median age, 73 versus 74; Pall-cause, 1.08; 95% confidence interval, 1.01-1.15 and 9.5% versus 9.1%; HRcardiovascular, 1.13; 95% confidence interval, 1.04-1.22). In contrast, risk-adjusted 30-day mortality was similar between transferred-in and direct arrivals (1.6% versus 1.6%; HR, 1.05; 95% confidence interval, 0.86-1.27). Conclusions-Transferred-in patients with acute MI are less likely to have outpatient clinic follow-up within 30 days and more likely to be readmitted within the first 30 days post discharge compared with direct-arrival patients. These results indicate room for improvement in the safe and seamless transition of care for transferred patients with MI traveling back to their home environments.

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