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.

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.

[1]  Lynn Unruh,et al.  Accountable care organizations in the USA: types, developments and challenges. , 2014, Health policy.

[2]  S. Normand,et al.  Trends in Hospitalizations and Outcomes for Acute Cardiovascular Disease and Stroke, 1999–2011 , 2014, Circulation.

[3]  Hagop S. Mekhjian,et al.  Diagnosis-specific readmission risk prediction using electronic health data: a retrospective cohort study , 2014, BMC Medical Informatics and Decision Making.

[4]  Jeremiah R. Brown,et al.  Health System Characteristics and Rates of Readmission After Acute Myocardial Infarction in the United States , 2014, Journal of the American Heart Association.

[5]  D. Mozaffarian,et al.  Heart disease and stroke statistics--2014 update: a report from the American Heart Association. , 2014, Circulation.

[6]  H. McGee,et al.  The HeartQoL: Part II. Validation of a new core health-related quality of life questionnaire for patients with ischemic heart disease , 2014, European journal of preventive cardiology.

[7]  H. McGee,et al.  The HeartQoL: Part I. Development of a new core health-related quality of life questionnaire for patients with ischemic heart disease , 2014, European journal of preventive cardiology.

[8]  C. Nemeroff,et al.  TREATMENT OF DEPRESSION IN CARDIOVASCULAR DISEASE , 2013, Depression and anxiety.

[9]  Leora I. Horwitz,et al.  Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. , 2013, JAMA.

[10]  P. de Jonge,et al.  Depression treatment after myocardial infarction and long-term risk of subsequent cardiovascular events and mortality: a randomized controlled trial. , 2013, Journal of psychosomatic research.

[11]  E. Hess,et al.  Transforming the emergency department observation unit: a look into the future. , 2012, Cardiology clinics.

[12]  A. Jaffe,et al.  Thirty-Day Rehospitalizations After Acute Myocardial Infarction , 2012, Annals of Internal Medicine.

[13]  Laine Thomas,et al.  International variation in and factors associated with hospital readmission after myocardial infarction. , 2012, JAMA.

[14]  Matthew M Davis,et al.  The Patient Protection and Affordable Care Act of 2010 , 2010, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[15]  K. Anstrom,et al.  Treatment with adenosine diphosphate receptor inhibitors-longitudinal assessment of treatment patterns and events after acute coronary syndrome (TRANSLATE-ACS) study design: expanding the paradigm of longitudinal observational research. , 2011, American heart journal.

[16]  Harlan M. Krumholz,et al.  An Administrative Claims Measure Suitable for Profiling Hospital Performance Based on 30-Day All-Cause Readmission Rates Among Patients With Acute Myocardial Infarction , 2011, Circulation. Cardiovascular quality and outcomes.

[17]  E John Orav,et al.  Thirty-day readmission rates for Medicare beneficiaries by race and site of care. , 2011, JAMA.

[18]  C. O’loughlin,et al.  Quality of life predicts outcome in a heart failure disease management program. , 2010, International journal of cardiology.

[19]  M. Desai,et al.  Statistical Models and Patient Predictors of Readmission for Acute Myocardial Infarction: A Systematic Review , 2009, Circulation. Cardiovascular quality and outcomes.

[20]  Mark V. Williams,et al.  Rehospitalizations among patients in the Medicare fee-for-service program. , 2009, The New England journal of medicine.

[21]  E. García Vicente,et al.  [Post-myocardial infarction depression]. , 2007, Anales de medicina interna.

[22]  K. Eagle,et al.  Validation of the EQ‐5D in patients with a history of acute coronary syndrome* , 2005, Current medical research and opinion.

[23]  F. Rodríguez‐Artalejo,et al.  Health-related quality of life as a predictor of hospital readmission and death among patients with heart failure. , 2005, Archives of internal medicine.

[24]  Sherry Holcomb,et al.  Validation of the EQ-5D quality of life instrument in patients after myocardial infarction , 2005, Quality of Life Research.

[25]  R. Spitzer,et al.  The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener , 2003, Medical care.

[26]  P. Stone,et al.  ST-segment elevation myocardial infarction , 2002, Current treatment options in cardiovascular medicine.

[27]  J. Popma,et al.  Impact of Smoking on Clinical and Angiographic Restenosis After Percutaneous Coronary Intervention: Another Smoker’s Paradox? , 2001, Circulation.

[28]  P. Toutouzas,et al.  In-hospital mortality of habitual cigarette smokers after acute myocardial infarction; the "smoker's paradox" in a countrywide study. , 2001, European heart journal.

[29]  C M Ashton,et al.  The association between the quality of inpatient care and early readmission: a meta-analysis of the evidence. , 1997, Medical care.

[30]  J. G. Douglas,et al.  Quality of life and hospital re-admission in patients with chronic obstructive pulmonary disease. , 1997, Thorax.

[31]  V. Boyko,et al.  Smoking and prognosis after acute myocardial infarction in the thrombolytic era (Israeli Thrombolytic National Survey). , 1996, Journal of the American College of Cardiology.