Unplanned Inpatient and Observation Rehospitalizations After Acute Myocardial Infarction: Insights From the Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE-ACS) Study

Connie N Hess; Tracy Y Wang; Lisa A McCoy; John C Messenger; Mark B Effron; Marjorie E Zettler; Timothy D Henry; Eric D Peterson; Gregg C Fonarow

doi:10.1161/CIRCULATIONAHA.115.017001

Unplanned Inpatient and Observation Rehospitalizations After Acute Myocardial Infarction: Insights From the Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE-ACS) Study

Circulation. 2016 Feb 2;133(5):493-501. doi: 10.1161/CIRCULATIONAHA.115.017001. Epub 2015 Dec 17.

Authors

Connie N Hess¹, Tracy Y Wang², Lisa A McCoy², John C Messenger², Mark B Effron², Marjorie E Zettler², Timothy D Henry², Eric D Peterson², Gregg C Fonarow²

Affiliations

¹ From Duke Clinical Research Institute, Durham, NC (C.N.H., T.Y.W., L.A.M., E.P.P.); Division of Cardiology, University of Colorado School of Medicine, Aurora, CO (J.C.M.); Lilly USA LLC, Indianapolis, IN (M.B.E., M.E.Z.); Cedars Sinai Heart Institute, Los Angeles, CA (T.D.H.); and Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles (G.C.F.). connie.hess@duke.edu.
² From Duke Clinical Research Institute, Durham, NC (C.N.H., T.Y.W., L.A.M., E.P.P.); Division of Cardiology, University of Colorado School of Medicine, Aurora, CO (J.C.M.); Lilly USA LLC, Indianapolis, IN (M.B.E., M.E.Z.); Cedars Sinai Heart Institute, Los Angeles, CA (T.D.H.); and Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles (G.C.F.).

PMID: 26680241
DOI: 10.1161/CIRCULATIONAHA.115.017001

Abstract

Background: Previous studies examining early readmission after acute myocardial infarction have focused exclusively on inpatient readmissions. However, from a patient's perspective, any unplanned inpatient or observation rehospitalization after acute myocardial infarction represents a significant event; these unplanned rehospitalizations have not been well characterized.

Methods and results: We examined all patients with acute myocardial infarction treated with percutaneous coronary intervention and discharged alive from 233 hospitals in the Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE-ACS) study from 2010 to 2012. Our primary outcome was unplanned rehospitalizations (inpatient or observation status) within 30 days after discharge. We identified factors associated with unplanned rehospitalizations using multivariable logistic regression. Among 12 312 patients, 1326 (10.8%) had 1483 unplanned rehospitalizations within 30 days of the index event: 1028 (69.3%) were inpatient readmissions, and 455 (30.7%) were observation stays. The majority of unplanned rehospitalizations (72%) were for cardiovascular reasons. Variation in hospital rates of 30-day unplanned rehospitalization ranged from 5.4% to 20.0%, with a median of 10.7%. After multivariable modeling, the factors most strongly associated with unplanned rehospitalization were baseline quality of life and depression, followed by index hospital length of stay.

Conclusions: Early unplanned rehospitalizations are common after acute myocardial infarction, and close to one third were classified as an observation stay. Predischarge and postdischarge assessments of overall, not just cardiovascular, health and strategies to optimize patient functional status may help to reduce unplanned rehospitalizations.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01088503.

Keywords: myocardial infarction; treatment outcome.

Publication types

Clinical Trial
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Acute Coronary Syndrome / diagnosis*
Acute Coronary Syndrome / epidemiology
Acute Coronary Syndrome / therapy*
Aged
Female
Humans
Longitudinal Studies
Male
Middle Aged
Myocardial Infarction / diagnosis*
Myocardial Infarction / epidemiology
Myocardial Infarction / therapy*
Patient Readmission / trends*
Percutaneous Coronary Intervention / trends
Purinergic P2Y Receptor Antagonists / therapeutic use*
Treatment Outcome

Substances

Purinergic P2Y Receptor Antagonists

Associated data

ClinicalTrials.gov/NCT01088503