Outcomes after readmission at the index or nonindex hospital following acute myocardial infarction complicated by cardiogenic shock

Abstract

Little is known about the prevalence and outcomes of readmission to nonindex hospitals after an admission for acute myocardial infarction complicated by cardiogenic shock (AMI‐CS). We aimed to determine the rate of nonindex readmissions following AMI‐CS and to evaluate its association with clinical factors, hospitalization cost, length of stay (LOS), and in‐hospital mortality rates. Hypothesis Nonindex readmission may lead to worse in‐hospital outcomes. Methods We reviewed the data of inpatients with AMI‐CS between 2010 and 2017 using the National Readmission Database. The survey analytical methods recommended by the Healthcare Cost and Utilization Project were used for national estimates. Multiple regression models were used to evaluate the predictors of nonindex readmission, and its association with hospitalization cost, LOS, and in‐hospital mortality rates. Results Of 238 349 patients with AMI‐CS, 28028 (11.76%) had an unplanned readmission within 30 days. Of these patients, 7423 (26.48%) were readmitted to nonindex hospitals. Compared with index readmission, nonindex readmission was associated with higher hospitalization costs (p < .0001), longer LOS (p < .0001), and increased in‐hospital mortality rates (p = .0016). Patients who had a history of percutaneous coronary intervention, received intubation/mechanical ventilation, or left against medical advice during the initial admission had greater odds of a nonindex readmission. Conclusions Over one‐fourth of readmissions following AMI‐CS were to nonindex hospitals. These admissions were associated with higher hospitalization costs, longer LOS, and higher in‐hospital mortality rates. Further studies are needed to evaluate whether a continuity of care plan in the acute hospital setting can improve outcomes after AMI‐CS.

Continuity of care after hospitalization due to cardiac conditions : Patients' perceptions, validity and reliability of a measure, and associations with outcomes

“…Several studies have evaluated the positive clinical effects of continuity of care, or interventions facilitating continuity of care, for patients with cardiac conditions. These clinical effects include reduced mortality and complications [29][30][31][32] , reduced healthcare utilization and fewer hospitalizations [32][33][34][35][36][37] , reduced 30-day readmission rate 29,32,[38][39][40][41][42][43][44][45][46] , reduced visits to the emergency department 32,34,37,45 , and shorter lengths of hospital stay (LOS) 29,31,47 . In addition, insufficient continuity is associated with inappropriate prescription medications (i.e., the use of drugs that should be avoided due to the high risk of adverse events) in patients with comorbidity 37 and serious adverse drug reactions in patients with atrial fibrillation using oral anticoagulation 48,49 .…”

“…It is difficult to compare the results in relation to cardiac diagnoses with previous studies. Some studies on continuity of care do not report specific diagnoses 182 , only include one diagnosis 17,[29][30][31][42][43][44]180 , only include one cardiac condition 33,34,37,40,41,89 or do not present their findings in a way that makes a comparison between diagnoses possible 38 . However, Valaker et al 180 found that patients with an acute clinical pathway, such as those hospitalized due to STEMI, perceived significantly higher levels of informational and management continuity than patients with a non-acute clinical pathway, such as stable angina pectoris.…”