Unplanned Inpatient and Observation Rehospitalizations After Acute Myocardial Infarction: Insights From the TRANSLATE-ACS Study.
Circulation. 2015 Dec 17;
Authors: Hess CN, Wang TY, McCoy LA, Messenger JC, Effron MB, Zettler ME, Henry TD, Peterson ED, Fonarow GC
Abstract
BACKGROUND: -Previous studies examining early readmission after acute myocardial infarction (MI) have focused exclusively on inpatient readmissions. Yet from a patient's perspective, any unplanned inpatient or observation rehospitalization after acute MI represents a significant event; these unplanned rehospitalizations have not been well-characterized.
METHODS AND RESULTS: -We examined all acute MI patients treated with percutaneous coronary intervention discharged alive from 233 hospitals in the TRANSLATE-ACS study from 2010-2012. Our primary outcome was unplanned rehospitalizations (inpatient or observation status) within 30 days post-discharge. We identified factors associated with unplanned rehospitalizations using multivariable logistic regression. Among 12,312 patients, 1,326 (10.8%) had 1,483 unplanned rehospitalizations within 30 days of the index event; 1,028 (69.3%) were inpatient readmissions, and 455 (30.7%) were observation stays. The majority of unplanned rehospitalizations (72%) were for cardiovascular reasons. Variation in hospital rates of 30-day unplanned rehospitalization ranged from 5.4% to 20.0%, with a median of 10.7%. After multivariable modeling, the factors most strongly associated with unplanned rehospitalization were baseline quality of life and depression, followed by index hospital length of stay.
CONCLUSIONS: -Early unplanned rehospitalizations are common after acute MI, and close to one-third were classified as an observation stay. Pre- and post-discharge assessments of overall, not just cardiovascular, health and strategies to optimize patient functional status may help to reduce unplanned rehospitalizations. Clinical Trial Registration Information-https://clinicaltrials.gov. Identifier: NCT01088503.
PMID: 26680241 [PubMed - as supplied by publisher]