Heart attack patients in USA more likely to be readmitted within 30 days
MedWire News: Patients in the USA who have experienced ST segment-elevation myocardial infarction (STEMI) are more likely to be readmitted to hospital within 30 days than patients in other countries, a study suggests.
However, this difference was greatly attenuated after adjusting for country-level length of stay, report Robb Kociol (Duke University, Durham, North Carolina, USA) and colleagues in JAMA.
They conducted a post hoc analysis of the Assessment of Pexelizumab in Acute Myocardial Infarction trial, which enrolled 5745 patients with STEMI at 296 sites in the USA, Canada, Australia, New Zealand, and 13 European countries between July 2004 and May 2006.
Of the 5571 patients who survived to hospital discharge, 631 (11.3%) patients were readmitted to hospital within 30 days.
The rate of readmission at 30 days was significantly higher in the USA than in other countries, at 14.5% versus 9.9% (p<0.001).
The median length of hospital stay was shortest for patients in the USA, at 3 days, and longest for patients in Germany, at 8 days.
After adjustment for baseline characteristics, multivessel disease, US enrollment, and baseline heart rate were significant predictors of 30-day readmission. Indeed, patients with multivessel disease had an 97% increased risk for 30-day readmission, and those enrolled in the USA a 68% increased risk. Baseline heart rate per 10/min increase was significantly associated with a 9% increased odds for 30-day readmission.
US enrollment was still an independent predictor for 30-day readmission after excluding elective readmission for revascularization, at an odds ratio of 1.53. However, after adjusting for country-level median length of stay, it was no longer an independent predictor for 30-day all-cause or nonelective readmission.
Further analysis revealed that US enrollment was not a significant predictor for inhospital death or 30-day postadmission death.
The authors conclude: "Further research is needed to better understand the relationship between [length of stay] and readmission rates and define and optimize overall efficiency of care internationally."
By Piriya Mahendra