Rate, causes, and predictors of 90‐day readmissions and the association with index hospitalization coronary revascularization following non‐ST elevation myocardial infarction in the United States

Abstract

Objectives To assess the causes and predictors of readmission after NSTEMI. Background Studies on readmissions following non‐ST elevation myocardial infarction (NSTEMI) are limited. We investigated the rate and causes for readmission and the impact of coronary revascularization on 90‐day readmissions following a hospitalization for NSTEMI in a large, nationally representative United States database. Methods We queried the National Readmission Database for the year 2016 using appropriate ICD‐10‐CM/PCS codes to identify all adult admissions for NSTEMI. We determined the 90‐day readmissions for major adverse cardiac events (MACE). All‐cause readmission was a secondary endpoint. The association between coronary revascularization and the likelihood of readmission was analyzed using multivariate Cox regression analysis. Results A total of 296,965 adult discharges following an admission for NSTEMI were included in this study. The rate of readmissions for MACE was 5.2% (n = 15,637) and for any cause was 18.0% (n = 53,316). 38% of MACE readmissions and 40% of all‐cause readmissions occurred between 30‐ and 90‐days following the index hospitalization. During index hospitalization, 51.0% underwent coronary revascularization (40.8% with PCI and 10.2% with CABG). This was independently predictive of a lower risk of 90‐day readmission for MACE (adjusted HR 0.59, 95% confidence interval (CI) 0.56–0.63, p < .001) and for any cause (adjusted HR 0.65, 95% CI 0.63–0.67, p < .001). In‐hospital mortality for MACE readmissions was significantly higher compared to that of index hospitalization (3.8% vs. 2.6%, p < .001). Conclusion Readmissions following NSTEMI carry higher mortality than the index hospitalization. Coronary revascularization for NSTEMI is associated with a lower readmission rate at 90 days.

Implications of Payment for Acute Myocardial Infarctions as a 90-Day Bundled Single Episode of Care: A Cost of Illness Analysis

“…This is important given recent evidence of high hospitalization burden in the 90 days post-discharge, with readmission rates ranging between 24–28% [ 5 , 11 ]. Moreover, 38% of major adverse CV event readmissions after AMI in the United States occur between 30 and 90 days after discharge [ 25 ], and the 90-day post-AMI period has been reported to be associated with an approximate 65% increase in AMI readmissions versus the 30-day period [ 11 ]. Thus, if reimbursements for acute care episodes in 90-day models are comparable to those of 30-day payment programs [ 21 – 24 ], moving from a typical 30-day reimbursement model to a 90-day model such as BPCI may increase the financial risk incurred by hospitals since they must pay the difference if the actual cost of care exceeds the fixed reimbursement given by the payment program [ 6 ].…”

Current management and prognosis of patients with recurrent myocardial infarction

“…The main reasons for readmission were heart failure (HF) and need for cardiac surgery (15.3% and 10.1%, respectively), while re-MI occurred in 2.1% of patients with an average number of days to MI recurrence of 35.3 ± 29.7. In another study investigating readmissions in 296,965 US patients discharged after NSTEMI, 58.4% of total readmissions at 90 days were due to CV causes, with re-MI being the most frequent [17]. Notably, the risk of re-MI persists even at longer follow-up and re-MI rates actually tend to rise over the years after the index MI (13-16% at 7 years), though more than half of events occur within the first year [18,19].…”

“…Similarly, prior CABG and PCI were significantly associated with re-MI in a prospective population of 9615 patients [31]. It should be noted, however, that both studies enrolled patients starting from 2004-2005, long before the modern antiplatelet strategies and second-generation drug-eluting stents (DES) have become available [16,17,19,[38][39][40][41][42].…”

Mental health disorders and readmissions following acute myocardial infarction in the United States

“…Recent United States (U.S.) nationwide data showed an increasing trend in the prevalence of MHD among patients hospitalized for acute myocardial infarction (MI) 3 . Hospital readmission following acute MI is associated with increased mortality and morbidity 4 ; however, the association of MHD and readmissions following acute MI hospitalization is not well studied. In a study limited to Mental Health Research Network (MHRN)-affiliated health systems evaluating patients admitted for acute MI, pneumonia and heart failure during 2009–2011, the rate of readmission was 5% greater for individuals with a past-year psychiatric comorbidity than for those without 5 .…”