Comparison of Readmission Rates After Acute Myocardial Infarction in 3 Patient Age Groups (18 to 44, 45 to 64, and ≥65 Years) in the United States

Abstract

Postacute myocardial infarction (AMI) readmissions are common among Medicare beneficiaries (≥65 years) and are associated with significant resource utilization. However, patterns of AMI readmissions for younger age groups in the United States are not known. In the Nationwide Readmissions Database, a nationally representative all-payer database of in-patient hospitalizations, we identified 212,171 index AMI hospitalizations in January to November 2013, weighted to represent 478,247 hospitalizations nationally (mean age 66.9 years, 38% women, 29% low income). This included 26,516 cases in the 18 to 44 age group, 183,703 in the 45 to 64 age group, and 268,027 in the ≥65 age group. The overall 30-day readmission rate was 14.5% and varied across age groups (9.7% [18 to 44], 11.2% [45 to 64], and 17.3% [≥65]). The cumulative cost of 30-day readmissions was $1.1 billion, of which $365 million was spent on those <65 years of age. In multivariable hierarchical models, the risk of readmission was higher in women and in low-income patients, but the effect varied by age (p value for age-gender and age-income interactions <0.05) and was more prominent in the younger age groups. Further, patients in all age groups continue to have a high hospitalization burden beyond the typical 30-day readmission period, with an overall 24% post-AMI 90-day readmission rate. In conclusion, readmissions in young and middle-aged AMI survivors pose a substantial burden on patients and on U.S. health-care resources. Women and low-income patients with AMI, particularly those in younger age groups, are more frequently readmitted, and readmissions continue to burden the health-care system beyond the typical 30-day window. Future investigations would need to be targeted toward a better understanding and improvement of the rehospitalization burden for vulnerable patient groups.

Thirty‐Day Readmission Rates, Timing, Causes, and Costs after ST‐Segment–Elevation Myocardial Infarction in the United States: A National Readmission Database Analysis 2010–2014

“…Similar to our data, prior studies have also indicated that the risk of readmission was higher in women compared with men, particularly in younger patients 24, 25. The analysis of the 2013 National Readmissions Database confirmed an unequal burden of readmissions on women, particularly in younger women 25.…”

“…Importantly, age was not found to be an independent predictor of 30‐day readmissions. Other studies have indicated that patients >65 years of age had higher risk‐adjusted odds for readmission 24. However, despite conflicting data regarding the association of 30‐day readmission with advanced age, the burden of readmission among younger patients still remains substantial.…”

“…Our estimates were derived from a 50% sample of US hospitals, and it is possible that the readmission cohort was either underrepresented or overrepresented by this sample. However, the NRD has been used extensively to examine national healthcare trends, and its sampling design has been validated in numerous publications 14, 24, 25. Second, miscoded and missing data can occur in large administrative data sets; however, Healthcare Cost and Utilization Project quality control procedures are routinely performed to confirm that NRD data values are valid, consistent, and reliable 35, 36.…”

The prevalence of 30‐day readmission after acute myocardial infarction: A systematic review and meta‐analysis

“…The 920 unique records after eliminating 184 duplication literatures would be further removed in a stepwise by the title, abstract, full‐text according to pre‐specified study inclusion and exclusion criteria. Ultimately, 14 observational studies met the eligibility criteria and were comprised in this systematic review, which the detailed filtering process was presented in Figure . Ten of the 14 studies were performed in the America, which the rest of individual studies were conducted Chain, France, Spain, and the United Kingdom (UK).…”

Adherence to guidelines for pharmacological treatment of young adults with myocardial infarction in Poland: Data from Polish Registry of Acute Coronary Syndromes (PL‐ACS)

“…3 Additionally, the readmission after MI is frequent among young patients, reaching almost 10% in a 30-day follow-up period. 4 The guidelines of the European Society of Cardiology (ESC) on the management in acute coronary syndrome (ACS) recommend polypharmacotherapy during hospitalization and after discharge. 5,6 Pharmacotherapy, as part of secondary prevention, reduces the risk of CV complications and overall mortality.…”