Unplanned Readmissions After Acute Myocardial Infarction: 1-Year Trajectory Following Discharge From a Safety Net Hospital

Abstract

Background: Financial penalties rendered by the Centers for Medicare and Medicaid Services have brought about new challenges for safety net hospitals that serve a vulnerable patient population with risk factors associated with high readmission rates. Our goal was to determine the 1-year trajectory of unplanned readmissions in post-myocardial infarction (MI) patients, and to identify factors associated with readmission. Methods: A total of 261 acute MI patients admitted from April 2015 to April 2016 were evaluated in a multidisciplinary cardiology clinic within 10 days of hospital discharge and baseline characteristics and medical comorbidities were collected. Readmission and mortality data were obtained at 1 year through chart review and telephone follow-up. Results: At 1 year, there were 90 (34%) unplanned readmissions of which half were for noncardiac diagnoses. Of these, 69 patients (77%) were readmitted once, 16 (18%) were readmitted twice, 2 (2%) were readmitted 3 times, and 3 (3%) were readmitted 4 times over the subsequent year. Cardiac causes of 1-year readmission included recurrent MI in 23 (9%) and decompensated heart failure in 18 (7%) patients. Depressed left ventricular systolic function (hazard ratio, 2.23; 95% confidence interval, 2.00–2.44; P = 0.0003) and diabetes mellitus (hazard ratio, 1.60; 95% confidence interval, 1.38–1.82; P = 0.029) were associated with a significantly higher risk of readmission at 1 year. Conclusion: Following acute MI, patients are readmitted for cardiac and noncardiac diagnoses well beyond the 30-day mark. This is likely a function of the vulnerability of the patient population rather than a reflection of the medical care provided. More frequent surveillance may attenuate this problem.

Development and Validation of a Risk Prediction Model for 1‐Year Readmission Among Young Adults Hospitalized for Acute Myocardial Infarction

“… 2 , 25 , 26 , 27 The few available risk models for 1‐year post‐AMI readmissions have been intervention specific, were developed in older populations, and did not capture patient‐reported outcomes. 28 , 29 , 30 , 31 Identifying which young adults hospitalized for AMI are at the highest risk for readmissions can inform the development of interventions that more effectively prevent readmission and improve outcomes in this population.…”

Prognostic Implications for Patients After Myocardial Infarction: an Integrative Literature Review and in-depth Interviews With Patients and Experts

“…Although follow-up subjects in most studies included all age groups, one study included women aged 60-80 years [17] and four studies included patients with ST-elevated MI [18][19][20][21]. The follow-up duration after MI was approximately 1 year in 6 studies [21][22][23][24][25][26] with the longest follow-up period being 13 years [27], followed by 10 years [17,28] and 8 years [20]. Adverse clinical outcomes as dependent variables were all-cause mortality [17,[19][20][21][22][23][24][28][29][30][31][32][33], cardiovascular mortality [18, 28, 34], recurrent cardiovascular events or HF [2,18,21,26,27,29], unplanned readmission [22,25], and reduced health-related quality of life [35].…”

“…Adverse clinical outcomes as dependent variables were all-cause mortality [17,[19][20][21][22][23][24][28][29][30][31][32][33], cardiovascular mortality [18, 28, 34], recurrent cardiovascular events or HF [2,18,21,26,27,29], unplanned readmission [22,25], and reduced health-related quality of life [35]. [17,18,20,25,31]. As prevalent diseases, hypertension [2,21,27,30,32], chronic kidney disease [2,24,29,33,35], prior stroke [19,30,35] and HF [25,26,28,29], atrial brillation [2,25,35] and multi-vessel involvement during infarction [19,36] were also found to be affecting factors.…”

“…[17,18,20,25,31]. As prevalent diseases, hypertension [2,21,27,30,32], chronic kidney disease [2,24,29,33,35], prior stroke [19,30,35] and HF [25,26,28,29], atrial brillation [2,25,35] and multi-vessel involvement during infarction [19,36] were also found to be affecting factors. Smoking as a lifestyle factor was identi ed as a factor that negatively affects the prognosis in several studies [19,22,27,28,30,33,36].…”

“…Long term follow-up cohort study analysis and affecting factors in patients with MI NSTEMI, non ST-segment elevation myocardial infarction; MI, myocardial infarction; ARB, angiotensin receptor blocker; eGFR, estimated glomerular ltration rate; HF, heart failure; KAMIR-NIH, Korea acute myocardial infarction registry-national institute of health; PCI, percutaneous coronary intervention;; and TIMI, thrombolysis in myocardial infarction. LVEF; left ventricular ejection fraction; MACE ; major adverse cardiovascular events Older age[2, 17, 18, 20, 22, 26, 28-31, 34, 36] and the recurrence of MI or angina[18,[22][23][24][25][26][27][28][32][33][34][35][36] were the most frequent factors affecting the adverse outcomes of post-MI patients, followed by diabetes prevalence[2, 18, 19, 22, 25-29, 31, 33, 35, 36], high Killip class[18,20,22,27,31, 36] and LVEF…”