Thirty-day rehospitalizations after acute myocardial infarction: a cohort study.

Abstract

BACKGROUND:

Rehospitalization is a quality-of-care indicator, yet little is known about its occurrence and predictors after myocardial infarction (MI) in the community.

OBJECTIVE:

To examine 30-day rehospitalizations after incident MI.

DESIGN:

Retrospective cohort study.

SETTING:

Population-based registry in Olmsted County, Minnesota.

PATIENTS:

3010 patients who were hospitalized in Olmsted County with first-ever MI from 1987 to 2010 and survived to hospital discharge.

MEASUREMENTS:

Diagnoses, therapies, and complications during incident and subsequent hospitalizations were identified. Manual chart review was performed to determine the cause of all rehospitalizations. The hazard ratios and cumulative incidence of 30-day rehospitalizations were determined by using Cox proportional hazards regression models.

RESULTS:

Among 3010 patients (mean age, 67 years; 40.5% female) with incident MI (31.2% ST-segment elevation), 643 rehospitalizations occurred within 30 days in 561 (18.6%) patients. Overall, 30.2% of rehospitalizations were unrelated to the incident MI and 42.6% were related; the relationship was unclear in 27.2% of rehospitalizations. Angiography was performed in 153 (23.8%) rehospitalizations. Revascularization was performed in 103 (16.0%) rehospitalizations, of which 46 (44.7%) had no revascularization during the index hospitalization. After adjustment for potential confounders, diabetes, chronic obstructive pulmonary disease, anemia, higher Killip class, longer length of stay during the index hospitalization, and a complication of angiography or reperfusion or revascularization were associated with increased rehospitalization risk. The 30-day incidence of rehospitalization was 35.3% in patients who experienced a complication of angiography during the index MI hospitalization and 31.6% in those who experienced a complication of reperfusion or revascularization during the index MI hospitalization, compared with 16.8% in patients who had reperfusion or revascularization without complications.

LIMITATION:

This study represents the experiences of a single community.

CONCLUSION:

Comorbid conditions, longer length of stay, and complications of angiography and revascularization or reperfusion are associated with increased 30-day rehospitalization risk after MI. Many rehospitalizations seem to be unrelated to the incident MI.

PRIMARY FUNDING SOURCE:

National Institutes of Health.

• Authors: Shannon M Dunlay, Susan A Weston, Jill M Killian, Malcolm R Bell, Allan S Jaffe, Véronique L Roger
• Journal: Annals of internal medicine (Ann Intern Med) Vol. 157 Issue 1 Pg. 11-8 (Jul 03 2012) ISSN: 1539-3704 [Electronic] United States
• PMID: 22751756 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Topics

• Aged
• Aged, 80 and over
• Confounding Factors, Epidemiologic
• Coronary Angiography (adverse effects)
• Female
• Hospitalization
• Humans
• Male
• Middle Aged
• Minnesota
• Myocardial Infarction (diagnostic imaging, therapy)
• Myocardial Reperfusion (adverse effects)
• Myocardial Revascularization (adverse effects)
• Patient Readmission (statistics & numerical data)
• Regression Analysis
• Retrospective Studies
• Time Factors