Thirty-day Hospital Readmissions in Patients with Non-ST-segment Elevation Acute Myocardial Infarction

Abstract

Background Limited data exist about relatively recent trends in the magnitude and characteristics of patients who are rehospitalized shortly after admission for a non ST-segment elevation acute myocardial infarction (NSTEMI). This observational study describes decade-long trends (1999-2009) in the magnitude and characteristics of patients readmitted to the hospital within 30 days of hospitalization for an incident (initial) episode of NSTEMI. Methods We reviewed the medical records of 2,249 residents of the Worcester (MA) metropolitan area who were hospitalized for an initial NSTEMI in 6 biennial periods between 1999 and 2009 at 3 central MA medical centers. Results The average age of our study population was 72 years, 90% were white, and 46% were women. The proportion of patients who were readmitted to the hospital for any cause within 30 days after discharge for a NSTEMI remained unchanged between 1999 and 2009 (approximately 15%) in both crude and multivariable adjusted analyses. Slight declines were observed for cardiovascular disease-related 30-day readmissions over the ten-year study period. Women, elderly patients, those with multiple chronic comorbidities, a prolonged index hospitalization, and patients who developed heart failure during their index hospitalization were at higher risk for being readmitted within 30-days than respective comparison groups. Conclusions Thirty day hospital readmission rates after hospital discharge for a first NSTEMI remained stable between 1999 and 2009. We identified several groups at higher risk for hospital readmission in whom further surveillance efforts and/or tailored educational and treatment approaches remain needed.

Seasonality and Readmission after Heart Failure, Myocardial Infarction, and Pneumonia

“…This is consistent with a small study based in Massachusetts, which looked at seasonality and readmission after MI and found a higher gross readmission rate in winter and spring, but this did not reach statistical significance given small sample size (Tisminetzky et al. ). In context of pneumonia, many diverse studies have found increases in incidence of respiratory bacterial and viral infections and hospitalization for community‐acquired pneumonia in winter or seasons of low temperature (Kim et al.…”

“…; Tisminetzky et al. ). However, all of these studies have been single‐center reports with small sample sizes and limited adjustment for other characteristics.…”

Predictors and etiologies of 30‐day readmissions in patients with non‐ST‐elevation acute coronary syndrome

“…The current study examines the incidence and predictors of 30‐day readmissions after NSTE‐ACS using a large‐scale administrative database. Despite the relevant burden this problem can pose, few studies have previously analyzed the readmissions rates after NSTE‐ACS . Dunlay et al showed that 18.6% of patients with acute myocardial infarction had a 30‐day readmission between 1987 and 2010 .…”

“…Similarly, Tisminetzky et al demonstrated a high but stable rate of readmission with NSTE‐ACS over the years 1999–2009. They also found a prolonged index hospitalization and significant baseline comorbidities as significant factors for readmission . Both studies showed a high rate of readmissions with NSTE‐ACS, however, they were derived from a single community database with large number of patients treated in prior decades, time before enormous advances and paradigm shift in the treatment of ACS occurred.…”

“…There is paucity of data in regard to the actual rate of readmissions after NSTE‐ACS . Hence, the burden of NSTE‐ACS readmissions still remains unclear.…”