Readmissions After Acute Myocardial Infarction: How Often Do Patients Return to the Discharging Hospital?

被引:17
作者
Rymer, Jennifer A. [1 ]
Chen, Anita Y. [2 ]
Thomas, Laine [2 ]
Fonarow, Gregg C. [3 ]
Peterson, Eric D. [1 ]
Wang, Tracy Y. [1 ]
机构
[1] Duke Univ, Med Ctr, Dept Med, Durham, NC 27710 USA
[2] Duke Clin Res Inst, Div Cardiol, Durham, NC USA
[3] Ronald Reagan UCLA Med Ctr, Div Cardiol, Los Angeles, CA USA
来源
JOURNAL OF THE AMERICAN HEART ASSOCIATION | 2019年 / 8卷 / 19期
关键词
length of stay; mortality; myocardial infarction; readmission; FRAGMENTATION; ASSOCIATION; CARE;
D O I
10.1161/JAHA.119.012059
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-When patients require readmission after a recent myocardial infarction (MI), returning to the discharging (index) hospital may be associated with better outcomes as a result of greater continuity in care. However, little evidence exists to answer this frequent patient question. Methods and Results-Among Medicare patients aged >= 65 years discharged home alive post-MI from 491 US hospitals in the ACTION (Acute Coronary Treatment Intervention Outcomes Network) Registry, we compared reason for readmission, duration of rehospitalization, and 30-day mortality between patients readmitted to the index versus nonindex hospital within 30 days of index MI discharge. Among 53 471 MI patients, 7715 (14%) were readmitted within 30 days, and most readmitted patients (73%) returned to the discharging hospital. Reason for readmission was not significantly associated with location of readmission. In multivariable modeling, the strongest factors associated with readmission to a nonindex hospital were distance from the discharging hospital, transfer-in during the index MI hospitalization, and frequency of nonindex hospital admissions in the year preceding to the index MI. Duration of rehospitalization did not differ significantly between patients readmitted to the index versus nonindex hospital (median, 4 versus 3 days; P=0.17). Mortality risk was also not significantly different between patients readmitted to the index versus nonindex hospital overall (7.4 versus 7.7%; adjusted odds ratio, 0.89; 95% CI, 0.73-1.10) and when stratified by reason for readmission (P for interaction=0.61). Conclusions-Post-MI readmissions did not differ in reason for readmission, duration of rehospitalization, or associated mortality when compared between patients who returned to the discharging hospital and those who sought care elsewhere.
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页数:14
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