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Original Research |

Thirty-Day Rehospitalizations After Acute Myocardial Infarction: A Cohort Study

Shannon M. Dunlay, MD, MSc; Susan A. Weston, MS; Jill M. Killian, BS; Malcolm R. Bell, MBBS; Allan S. Jaffe, MD; and Véronique L. Roger, MD, MPH
[+] Article and Author Information

From Mayo Clinic, Rochester, Minnesota.

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, roger.veronique@mayo.edu.

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.


Ann Intern Med. 2012;157(1):11-18. doi:10.7326/0003-4819-157-1-201207030-00004
Text Size: A A A

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.

Figures

Grahic Jump Location
Figure.

Distribution of 643 rehospitalizations within 30 days of incident MI.

MI = myocardial infarction.

Grahic Jump Location

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Comments

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continuity of care in 30 day rehospitalizations after MI
Posted on July 5, 2012
Steven H. Smoger, MD, FACP
Robley Rex Veterans Administration Medical Center, Louisville, KY
Conflict of Interest: None Declared
After reading the article by Dunlay et al in which they investigate the reasons for rehospitalizations within 30 days of an incident MI, I wonder if the authors looked into the arrangements at discharge for follow up with either a primary care provider or a cardiac or other specialist. As hospitalists have become the norm during admissions and primary care providers focus on office practice. issues arise regarding communication and timely followup. In addition did the authors look for evidence of skilled nursing arrangements (either in home or a rehab facility)?
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