Impact of Clinical Pharmacist Interventions on 30-Day Readmission Rate in Hospitalized Patients With Acute Myocardial Infarction

Abstract

Acute myocardial infarction (AMI) in the United States has an estimated annual incidence of 515 000 new attacks and 205 000 recurrent attacks. 1 Although advances in treatment have decreased the number of deaths due to AMI, a large number of AMI survivors are being dismissed from the hospital into the community and are at risk for readmission. 2,3 Many factors may affect early readmission rates for AMI including comorbidities, environmental factors, insufficient discharge planning, nonadherence to medication therapy, and a reduced level of health literacy. 4 Heart failure, renal disorders, and pneumonia are 3 common readmission diagnoses following AMI, with heart failure being the most common. 5 Acute myocardial infarction has been identified by the Medicare Payment Advisory Commission as a common, costly cause of hospitalization, with a high proportion of potentially preventable readmissions. 6 In October 2012, the Patient Protection and Affordable Care Act allowed the Centers for Medicare and Medicaid Services to begin penalizing hospitals with readmission rates greater than the national average for AMI, heart failure, and pneumonia. 7 As a result, 30-day readmission rates have become key quality outcome measures for most hospitals.Clinical pharmacists can help reduce hospital readmission rates. Pharmacists have the training and expertise needed to provide medication-related education and to resolve medication-related problems at discharge, which may reduce preventable adverse events, hospital readmissions, and visits to the emergency room. 8 Schnipper et al 9 demonstrated that pharmacist medication review, patient 551756P MTXXX10.

Factors affecting hospital readmission rates following an acute coronary syndrome: A systematic review

“…The RCT studies scored 10 (maximum quality score 13) (Cajanding, 2017). The quasi‐experimental study scored 8/9 (Gasbarro et al, 2015).…”

“…This review included five prospective cohort studies (Dodson et al, 2019; Hess et al, 2016; Li et al, 2019; Litovchik et al, 2019; McManus et al, 2016), 17 retrospective cohort studies (Atti et al, 2019; Borzecki et al, 2016; Cheung et al, 2018; Dharmarajan et al, 2013; Dreyer et al, 2015; Khera et al, 2017; Kociol et al, 2012; Mahmoud & Elgendy, 2018; McHugh & Ma, 2013; Meadows et al, 2012; Nuti et al, 2016; Przybysz‐Zdunek et al, 2012; Rodriguez et al, 2011; Southern et al, 2014; Tripathi et al, 2017, 2019; Zabawa et al, 2018), one RCT (Cajanding, 2017) and one quasi‐experimental (Gasbarro et al, 2015). The sample size of studies ranged from 50 (Gasbarro et al, 2015) to 212,171 (Khera et al, 2017). The majority of studies were conducted in the USA (Atti et al, 2019; Borzecki et al, 2016; Cheung et al, 2018; Dharmarajan et al, 2013; Dodson et al, 2019; Dreyer et al, 2015; Gasbarro et al, 2015; Hess et al, 2016; Khera et al, 2017; Kociol et al, 2012; Mahmoud & Elgendy, 2018; McHugh & Ma, 2013; McManus et al, 2016; Meadows et al, 2012; Nuti et al, 2016; Tripathi et al, 2017, 2019), two studies in Canada (Kociol et al, 2012; Southern et al, 2014) and one in France (Zabawa et al, 2018), Spain (Rodriguez et al, 2011), Poland (Przybysz‐Zdunek et al, 2012), Israel (Litovchik et al, 2019), Philippines (Cajanding, 2017) and China (Li et al, 2019).…”

“…All included studies (n = 24) were published in English between 2001 and 2020. This review included five prospective cohort studies (Dodson et al, 2019;Hess et al, 2016;Li et al, 2019;Litovchik et al, 2019;McManus et al, 2016), 17 retrospective cohort studies (Atti et al, 2019;Borzecki et al, 2016;Cheung et al, 2018;Dharmarajan et al, 2013;Dreyer et al, 2015;Khera et al, 2017;Kociol et al, 2012;Mahmoud & Elgendy, 2018;McHugh & Ma, 2013;Meadows et al, 2012;Nuti et al, 2016;Przybysz-Zdunek et al, 2012;Rodriguez et al, 2011;Southern et al, 2014;Tripathi et al, 2017Tripathi et al, , 2019Zabawa et al, 2018), one RCT (Cajanding, 2017) and one quasi-experimental (Gasbarro et al, 2015). The sample size of studies ranged from 50 (Gasbarro et al, 2015) to 212,171 (Khera et al, 2017).…”

“…Of the 24 studies reviewed, five studies did not report cardiac factors as the principal diagnosis for hospital readmission (Borzecki et al, 2016;Gasbarro et al, 2015;Khera et al, 2017;Nuti et al, 2016;Zabawa et al, 2018). However, a recurrent ischaemic event, including re-infarction and unstable angina, was consistently reported as the leading cause of readmission in 12 studies (Cajanding, 2017;Dharmarajan et al, 2013;Dreyer et al, 2015;Hess et al, 2016;Kociol et al, 2012;Li et al, 2019;Litovchik et al, 2019;McManus et al, 2016;Przybysz-Zdunek et al, 2012;Rodriguez et al, 2011;Tripathi et al, 2017Tripathi et al, , 2019.…”

Credentialing and privileging for clinical pharmacists

“…Clinical pharmacist participation in team‐based care can result in decreased hospital stays, reduced number of 30‐day hospital readmissions, increased use of evidence‐based therapies, improved quality performance metrics, enhanced medication adherence, and reduced total costs of care . However, despite evidence supporting improved quality of care with clinical pharmacist participation on the team, there remains a need to document that the clinical pharmacist's competence and experience attest to his or her ability to carry out specific clinical responsibilities.…”