TY - JOUR
T1 - Readmissions After Acute Myocardial Infarction
T2 - How Often Do Patients Return to the Discharging Hospital?
AU - Rymer, Jennifer A.
AU - Chen, Anita Y.
AU - Thomas, Laine
AU - Fonarow, Gregg C.
AU - Peterson, Eric D.
AU - Wang, Tracy Y.
N1 - Funding Information:
Thomas reports research grants to the Duke Clinical Research Institute from Boston Scientific Corporation, Gilead Sciences, Inc, Janssen Scientific Affairs, Johnson & Johnson, and Novartis Pharmaceuticals. Fonarow reports research support from the National Institutes of Health; has received consulting fees from Abbott, Amgen, Novartis, Medtronic, and St Jude Medical; and serves as a Get With The Guidelines Steering Committee member. Peterson reports research grants to the Duke Clinical Research Institute from Abiomed, Amgen, Inc, AstraZeneca, Bayer AG, Genentech, Janssen Pharmaceutical, Merck & Co, Regeneron Pharmaceuticals, Sanofi‐Aventis, and Society of Thoracic Surgeons, as well as consulting or honoraria from Bayer AG, Janssen Pharmaceutical, and Sanofi‐Aventis. Wang reports research grants to the Duke Clinical Research Institute from AstraZeneca, Boston Scientific, CryoLife, Inc, Daiichi Sankyo, Eli Lilly, Gilead Sciences, GlaxoSmithKline, Novartis Pharmaceutical Company, and Regeneron.
Publisher Copyright:
© 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Background: When patients require readmission after a recent myocardial infarction (MI), returning to the discharging (index) hospital may be associated with better outcomes as a result of greater continuity in care. However, little evidence exists to answer this frequent patient question. Methods and Results: Among Medicare patients aged ≥65 years discharged home alive post-MI from 491 US hospitals in the ACTION (Acute Coronary Treatment Intervention Outcomes Network) Registry, we compared reason for readmission, duration of rehospitalization, and 30-day mortality between patients readmitted to the index versus nonindex hospital within 30 days of index MI discharge. Among 53 471 MI patients, 7715 (14%) were readmitted within 30 days, and most readmitted patients (73%) returned to the discharging hospital. Reason for readmission was not significantly associated with location of readmission. In multivariable modeling, the strongest factors associated with readmission to a nonindex hospital were distance from the discharging hospital, transfer-in during the index MI hospitalization, and frequency of nonindex hospital admissions in the year preceding to the index MI. Duration of rehospitalization did not differ significantly between patients readmitted to the index versus nonindex hospital (median, 4 versus 3 days; P=0.17). Mortality risk was also not significantly different between patients readmitted to the index versus nonindex hospital overall (7.4 versus 7.7%; adjusted odds ratio, 0.89; 95% CI, 0.73–1.10) and when stratified by reason for readmission (P for interaction=0.61). Conclusions: Post-MI readmissions did not differ in reason for readmission, duration of rehospitalization, or associated mortality when compared between patients who returned to the discharging hospital and those who sought care elsewhere.
AB - Background: When patients require readmission after a recent myocardial infarction (MI), returning to the discharging (index) hospital may be associated with better outcomes as a result of greater continuity in care. However, little evidence exists to answer this frequent patient question. Methods and Results: Among Medicare patients aged ≥65 years discharged home alive post-MI from 491 US hospitals in the ACTION (Acute Coronary Treatment Intervention Outcomes Network) Registry, we compared reason for readmission, duration of rehospitalization, and 30-day mortality between patients readmitted to the index versus nonindex hospital within 30 days of index MI discharge. Among 53 471 MI patients, 7715 (14%) were readmitted within 30 days, and most readmitted patients (73%) returned to the discharging hospital. Reason for readmission was not significantly associated with location of readmission. In multivariable modeling, the strongest factors associated with readmission to a nonindex hospital were distance from the discharging hospital, transfer-in during the index MI hospitalization, and frequency of nonindex hospital admissions in the year preceding to the index MI. Duration of rehospitalization did not differ significantly between patients readmitted to the index versus nonindex hospital (median, 4 versus 3 days; P=0.17). Mortality risk was also not significantly different between patients readmitted to the index versus nonindex hospital overall (7.4 versus 7.7%; adjusted odds ratio, 0.89; 95% CI, 0.73–1.10) and when stratified by reason for readmission (P for interaction=0.61). Conclusions: Post-MI readmissions did not differ in reason for readmission, duration of rehospitalization, or associated mortality when compared between patients who returned to the discharging hospital and those who sought care elsewhere.
KW - length of stay
KW - mortality
KW - myocardial infarction
KW - readmission
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U2 - 10.1161/JAHA.119.012059
DO - 10.1161/JAHA.119.012059
M3 - Article
C2 - 31537135
AN - SCOPUS:85072392150
VL - 8
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
SN - 2047-9980
IS - 19
M1 - e012059
ER -