Predicting Readmission or Death After Acute ST‐Elevation Myocardial Infarction

Abstract

Background Risk factors for emergent readmissions or death after acute myocardial infarctions (AMI) are important to identifying patients at risk for major adverse events. However limited investigation in prospective clinical registries have been conducted to determine relevant risk factors. Methods Patients presenting with STEMI from 2006 to 2011 were prospectively enrolled in a STEMI registry (1,271). Thirty-day readmission was ascertained by administrative claims data. Death was determined by linking to the Social Security Death Master File. Univariate and stepwise multivariate logistic regression was conducted with Hosmer-Lemeshow goodness-of-fit statistics for model calibration and receiver operating characteristic curve for model discrimination. Results The combined endpoint of 30-day readmission or post discharge death included 135 patients (10.6%), including 109 emergent readmissions and 26 deaths. Factors associated with an increase risk of 30-day readmission or post discharge death age≥80 years, diabetes, chest pain or cardiac arrest at presentation and 3-vessel disease found at initial angiography. Factors associated with a decreased risk of 30-day readmission or post discharge death included transfer to the cath-lab from another emergency department, given during the procedure hypercholesterolemia, and receiving aspirin, beta-blockers, and ACE or ARB inhibitors at discharge. Index admission outcomes indicative of readmission or death post discharge only included a new diagnosis of congestive heart failure. The model discriminated well with an ROC of 0.71 (95%CI 0.66, 0.76). Conclusions Pre-hospitalization factors are overlooked and important factors to incorporate in routine risk prediction models for readmission or death within thirty days following an AMI.

Predicting unplanned readmission after myocardial infarction from routinely collected administrative hospital data

“…In fact, the top predictive variables also include prior emergency attendances or hospitalisations for both 30-day ischaemic heart disease readmission and 12-month all-cause readmission, and these agree with a recent finding. 41 There are several limitations of the present study. First, the study was performed in a single centre and the EMR model has not been independently and externally validated.…”

Risk Factors for 30-Day Readmissions after Acute Myocardial Infarction

“…7,21 In our sample, 43% of the readmissions were cardiac related, 14% due to acute CHF, 11% due to reinfarction (most of them NSTEMI) and almost 5% arrhythmia-related. Pulmonary, gastrointestinal, infectious and renal causes account for another significant amount of the readmissions, emphasizing that comprehensive strategies of care in patients with AMI need to be deployed to incorporate timely treatment of both cardiovascular and non-cardiovascular diseases to prevent future hospitalizations.…”

“…6,11,21,22,23,24 However, it is difficult to directly compare rates, due to several factors: previous analysis have focused only on Medicare patients 7,10 , only patients with STEMI 21 , or only patients undergoing PCI (percutaneous coronary intervention) 23,24 .…”

“…Compared to previously developed 30-day readmission models, our model has better discrimination with ROC curves as those range between 0.63 and 0.67. 21,23,24,28 …”

“…To completely ascertain the end point of readmission, it has been suggested to use Medicare data 10 . Nonetheless, this approach would only analyze patients over the age of 65 years and not include health maintenance organization (HMO)-covered beneficiaries under Medicare, which in our sample were 9%, but in some geographic regions can represent more than 50% 21 . On the other hand, hospitallevel adjusted readmission rates developed using Medicare claims have been demonstrated to be highly correlated to the use of hospital medical records, (correlation, 0.98).…”