Readmission and processes of care across weekend and weekday hospitalisation for acute myocardial infarction, heart failure or stroke: an observational study of the National Readmission Database

Abstract

ObjectivesVariation in hospital resource allocations across weekdays and weekends have led to studies of the ‘weekend effect’ for ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), heart failure (HF) and stroke. However, few studies have explored the ‘weekend effect’ on unplanned readmission. We aimed to investigate 30-day unplanned readmissions and processes of care across weekend and weekday hospitalisations for STEMI, NSTEMI, HF and stroke.DesignWe grouped hospitalisations for STEMI, NSTEMI, HF or stroke into weekday or weekend admissions. Multivariable adjusted ORs for binary outcomes across weekend versus weekday (reference) groups were estimated using logistic regression.SettingWe included all non-elective hospitalisations for STEMI, NSTEMI, HF or stroke, which were recorded in the US Nationwide Readmissions Database between 2010 and 2014.ParticipantsThe analysis sample included 659 906 hospitalisations for STEMI, 1 420 600 hospitalisations for NSTEMI, 3 027 699 hospitalisations for HF, and 2 574 168 hospitalisations for stroke.Main outcome measuresThe primary outcome was unplanned 30-day readmission. As secondary outcomes, we considered length of stay and the following processes of care: coronary angiography, primary percutaneous coronary intervention, coronary artery bypass graft, thrombolysis, brain scan/imaging, thrombectomy, echocardiography and cardiac resynchronisation therapy/implantable cardioverter-defibrillator.ResultsUnplanned 30-day readmission rates were 11.0%, 15.1%, 23.0% and 10.9% for STEMI, NSTEMI, HF and stroke, respectively. Weekend hospitalisations for HF were associated with a statistically significant but modest increase in 30-day readmissions (OR of 1.045, 95% CI 1.033 to 1.058). Weekend hospitalisation for STEMI, NSTEMI or stroke was not associated with increased risk of 30-day readmission.ConclusionThere was no clinically meaningful evidence against the supposition that weekend and weekday hospitalisations have the same 30-day unplanned readmissions. Thirty-day readmission rates were high, especially for HF, which has implications for service provision. Strategies to reduce readmission rates should be explored, regardless of day of hospitalisation.

Predictors of Early (0-7 Days) and Late (8-30 Days) Readmission in a Cohort of Acute Coronary Syndrome Patients

“… 20 – 24 Similarly, other studies have shown that 30-day readmission rates are greater for NSTEMI compared to STEMI patients. 25 , 26 While our results were concordant with these studies, our study is one of the first to limit the analysis to the first 7 days (rather than first 30 days). These three characteristics likely represent a combination of recurrent and difficult-to-control conditions (e.g., rate control in atrial fibrillation) and patients with more complex underlying disease or comorbidities (NSTEMI and ICU admission).…”

Medicines optimization prior to discharge in patients admitted to hospital with heart failure

“…Of those who survive to discharge, one in four patients will be readmitted and one in eight will die within a month of admission. 9 , 31 Quadruple therapy can reduce the risk of cardiovascular death or HF hospitalization by 62% compared with treatment with ACE‐I or ARB plus beta‐blocker alone, 1 and the time to onset of benefit of several HF medications is known to be <1 month. 2 , 3 , 4 As a result, guidelines recommend that patients are seen within 2 weeks of discharge by an HF specialist, 6 but fewer than half of care providers can meet this target.…”