Shannon M. Dunlay, MD, MSc; Susan A. Weston, MS; Jill M. Killian, BS; Malcolm R. Bell, MBBS; Allan S. Jaffe, MD; Véronique L. Roger, MD, MPH
Grant Support: By grants from the National Institutes of Health (RO1-HL59205) and the Rochester Epidemiology Project (R01-AR30582, from the National Institute of Arthritis and Musculoskeletal and Skin Diseases).
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-2526.
Reproducible Research Statement:Study protocol, statistical code, and data set: Not available.
Requests for Single Reprints: Véronique L. Roger, MD, MPH, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Dunlay, Bell, and Roger; Ms. Weston; and Ms. Killian: Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Dr. Jaffe: Mayo Clinic, Cardiovascular Division, 5th Floor, Gonda Building, Rochester, MN 55905.
Author Contributions: Conception and design: S.M. Dunlay, V.L. Roger.
Analysis and interpretation of the data: S.M. Dunlay, S.A. Weston, J.M. Killian, M.R. Bell, A.S. Jaffe, V.L. Roger.
Drafting of the article: S.M. Dunlay, A.S. Jaffe.
Critical revision of the article for important intellectual content: S.M. Dunlay, S.A. Weston, M.R. Bell, A.S. Jaffe, V.L. Roger.
Final approval of the article: S.M. Dunlay, M.R. Bell, A.S. Jaffe, V.L. Roger.
Provision of study materials or patients: S.M. Dunlay, V.L. Roger.
Statistical expertise: S.M. Dunlay, S.A. Weston.
Obtaining of funding: V.L. Roger.
Collection and assembly of data: S.M. Dunlay, S.A. Weston, J.M. Killian.
Dunlay SM, Weston SA, Killian JM, Bell MR, Jaffe AS, Roger VL. Thirty-Day Rehospitalizations After Acute Myocardial Infarction: A Cohort Study. Ann Intern Med. 2012;157:11-18. doi: 10.7326/0003-4819-157-1-201207030-00004
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Published: Ann Intern Med. 2012;157(1):11-18.
Rehospitalization is a quality-of-care indicator, yet little is known about its occurrence and predictors after myocardial infarction (MI) in the community.
To examine 30-day rehospitalizations after incident MI.
Retrospective cohort study.
Population-based registry in Olmsted County, Minnesota.
3010 patients who were hospitalized in Olmsted County with first-ever MI from 1987 to 2010 and survived to hospital discharge.
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.
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.
This study represents the experiences of a single community.
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.
National Institutes of Health.
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Acute Coronary Syndromes, Cardiology, Coronary Heart Disease, Emergency Medicine, Hospital Medicine.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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