Discharge Against Medical Advice After Percutaneous Coronary Intervention in the United States

Kwok, Chun Shing; Bell, Malcolm R.; Anderson, H. Vernon; Shaibi, Khaled Al; Gulati, Rajiv; Potts, Jessica; Rashid, Muhammad; Kontopantelis, Evangelos; Bagur, Rodrigo; Mamas, Mamas A.

doi:10.1016/j.jcin.2018.03.049

Cited by 16 publications

(17 citation statements)

References 15 publications

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“…Patients with alcohol and drug abuse were more likely to discharge AMA, consistent with previous ndings. [10,17,18] Both alcohol and drugs can impair cognition and lead to impulsive or risky behavior, prompting the patient's subsequent decision to leave AMA. [19] In addition, patients who are dependent on drugs and/or alcohol may be more likely to leave the hospital toobtain dependent substances, especially if withdrawal symptoms are not properly treated.…”

Section: Discussionmentioning

confidence: 99%

“…[9] In patients who underwent PCI, AMA discharge was a strong predictor for readmission, and associated with greater mortality. [10] However, little has been known about the impact of AMA discharge in sepsis patients. Using the National Readmission Database (NRD) of the U.S., Shruti et al evaluated the factors associated with 30-day readmission in patients with sepsis, while they classi ed patients who left AMA into other discharge group.…”

Section: Introductionmentioning

confidence: 99%

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Discharge Against Medical Advice and Risk of Readmission After Sepsis Hospitalization

Lin

Zhai

Han

et al. 2020

Preprint

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Background: To describe characteristics of sepsis patients who discharged against medical advice (AMA), identify factors associated with AMA discharges in the patients, and evaluate the association of AMA discharge with 30-day unplanned readmission and outcomes of readmission.Methods: Using the National Readmission Database of the United States, we identified inpatients with sepsis who discharged AMA or discharged home between 2010 and 2017. The baseline characteristics were compared between the two groups. Multivariable models were used to identify factors related to AMA discharge, evaluate the association between AMA discharge and 30-day unplanned readmission, and elucidate the relationship between the AMA discharges and in-hospital outcomes.Results: AMA discharges accounted for 2.29% of all the hospitalized sepsis patients. The prevalence of AMA discharge in sepsis patients increased from 1.99% in 2010 to 2.55% in 2014 (p for trend < 0.001).The unplanned 30-day readmission rates of sepsis patients who discharged AMA and who discharged home are 25.51% and 12.26%, respectively. AMA discharge is statistically significantly associated with 30-day [odds ratio (OR), 2.24; 95% confidence interval (CI), 2.15–2.33], 60-day (OR, 2.07; 95% CI, 1.99–2.15), and 90-day (OR, 1.97; 95% CI, 1.90–2.05) readmission. AMA discharge is also associated with longer length of stay in 30 days (0.44 day, 95% CI, 0.12 days-0.76 days, p=0.007), whereas there was no statistically significant difference in hospitalization costs and in-hospital mortality for patients discharged AMA versus those discharged home.Conclusions: Due to the high risk of readmission, vulnerable patients should be early identified. Medical institutions should conduct post-discharge interventions for patients with AMA discharge, such as follow-up visits and psychological counseling, to reduce readmission.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Discharge Against Medical Advice and Risk of Readmission After Sepsis Hospitalization

Lin

Zhai

Han

et al. 2020

Preprint

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“…Efforts to understand the drivers of readmission after AMI and percutaneous coronary intervention (PCI) have identified clinical predictors including sex, alcohol misuse, insurance type, discharge against medical advice (DAMA), comorbidity burden, quality of life, depression and ST-segment elevation myocardial infarction (STEMI) 3–5 10–15…”

Section: Introductionmentioning

confidence: 99%

Association between age and readmission after percutaneous coronary intervention for acute myocardial infarction

Qin

Wei

Han

et al. 2020

Heart

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ObjectiveThis study aimed to investigate the association between age and the risk of 30-day unplanned readmission among adult patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI).MethodsThis retrospective analysis included patients from the Nationwide Readmissions Database with AMI who underwent PCI during 2013–2014. We used multivariable logistic regression model to calculate adjusted odds ratios (AORs) for risk of readmission. To examine potential non-linear association, we performed logistic regression with restricted cubic splines (RCS).ResultsOf the 492 550 patients with AMI aged above 18 years undergoing PCI during the index hospitalisation, 48 630 (9.87%) were readmitted within 30 days. Although the crude readmission rate of younger patients (aged 18–54 years) was the lowest (7.27%), younger patients had higher risk of readmission compared with patients aged 55–64 years for all-causes (AOR 1.06 (1.01 to 1.11), p=0.0129) and specific causes, such as AMI and chest pain (both cardiac and non-specific) after adjusted for covariates. Patients aged 65–74 years were at lower risk of all-cause readmission. Older patients (age ≥75 years) had higher risk of readmission for heart failure (AOR 1.50 (1.29 to 1.74)) and infection (AOR 1.44 (1.16 to 1.79)), but lower risk for chest pain. RCS analyses showed a U-shaped relationship between age and readmission risk.ConclusionsOur results suggest higher risk of readmission in younger patients for all-cause unplanned readmission after adjusted for covariates. The trends of readmission risk along with age were different for specific causes. Age-targeted initiatives are warranted to reduce preventable readmissions in patients with AMI undergoing PCI.

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“…The key difference seen in both the studies in India and developed countries is the fact that in developing countries cost seems to be the major factor for DAMA and in developed world alcohol and substance addiction seem to the common reason for DAMA. This contrasting difference is only brought forward because of these two studies, as most of the evidence surrounding DAMA/LAMA comes from developed world 2,7 .…”

mentioning

confidence: 99%

“…It is also important to understand that the outcome of these patients remains unknown more often than not, as they are lost to follow-up. In group of patients who underwent a percutaneous coronary intervention and were discharged against medical advice, they were twice as likely to be readmitted and possibly have a poor outcome 2 . There is a significant ethical, legal and clinical challenge in managing these patients.…”

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confidence: 99%

Contra Consilium Medicinae: A Strange Malady Affecting Indian Healthcare!!

Pandit

Kulkarni

2019

Indian Journal of Critical Care Medicine

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Discharge Against Medical Advice After Percutaneous Coronary Intervention in the United States

Abstract: DAMA occurs in approximately 0.5% of patients following PCI and is strongly associated with readmission within 30 days. Interventions should be developed to reduce DAMA in high-risk groups and initiate interventions to avoid complications and readmission when it occurs.

Cited by 16 publications

References 15 publications

Discharge Against Medical Advice and Risk of Readmission After Sepsis Hospitalization

Discharge Against Medical Advice and Risk of Readmission After Sepsis Hospitalization

Association between age and readmission after percutaneous coronary intervention for acute myocardial infarction

Contra Consilium Medicinae: A Strange Malady Affecting Indian Healthcare!!

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