Thirty-Day Hospital Readmission After Acute Myocardial Infarction in China

Abstract

Background: Readmission after acute myocardial infarction in low- and middle-income countries like China is not well characterized. Methods and Results: We approached consecutive patients with acute myocardial infarction hospitalized within 24 hours of symptom onset and discharged alive from 53 geographically diverse hospitals in China. We described rates of unplanned 30-day readmission, their timing and admitting diagnoses, and fit Cox proportional hazards models to identify factors associated with readmission. Among 3387 patients, median (interquartile range) age was 61 (52–69) years, and 76.9% were men. The index median length of stay was 11 (8–14) days. Unplanned 30-day readmission occurred in 6.3% of the cohort; most readmissions (77.7%) were for cardiovascular diagnoses. Nearly half (41.9% of all-cause readmissions; 44.3% of cardiovascular readmissions) occurred within 5 days of discharge. Mini-Global Registry of Acute Coronary Events scores at admission (hazard ratio [HR], 1.15 for every 10-point increase; 95% CI, 1.05–1.25), longer length of stay (HR, 1.03; 95% CI, 1.00–1.06 for each extra day), and in-hospital recurrent angina (HR, 1.40; 95% CI, 1.04–1.89) were associated with higher unplanned all-cause readmission. Revascularization during the index hospitalization (70.2% of the cohort) was associated with lower risks of all-cause readmission (HR, 0.27; 95% CI, 0.18–0.42). In addition, left ventricular ejection fraction <0.4 (HR, 1.79; 95% CI, 1.05–3.07) and in-hospital complication (HR, 1.20; 95% CI, 1.03–1.39) were associated with higher risk of unplanned cardiovascular readmission, and ST-segment–elevation myocardial infarction (HR, 0.60; 95% CI, 0.36–0.98) was associated with lower risk of unplanned cardiovascular readmission. Sex, family income, depression, stress level, lower social support, disease-specific health status, and medications were not associated with readmission. Conclusions: In China, most readmissions are for cardiovascular events, and almost half occur within 5 days of discharge. Clinical factors identify patients at higher and lower unplanned readmissions. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01624909.

The prevalence of 30‐day readmission after acute myocardial infarction: A systematic review and meta‐analysis

“…The 920 unique records after eliminating 184 duplication literatures would be further removed in a stepwise by the title, abstract, full‐text according to pre‐specified study inclusion and exclusion criteria. Ultimately, 14 observational studies met the eligibility criteria and were comprised in this systematic review, which the detailed filtering process was presented in Figure . Ten of the 14 studies were performed in the America, which the rest of individual studies were conducted Chain, France, Spain, and the United Kingdom (UK).…”

Air pollution and recurrence of cardiovascular events after ST-segment elevation myocardial infarction

“…In recent years, the hospitalization rate of STEMI in China has sharply increased, imposing a heavy burden on the national economy [1,2]. In spite of the widespread use of reperfusion therapy and secondary prophylactics, discharged patients after STEMI still have a poor prognosis and a high risk of readmission due to the recurrent cardiovascular events [3][4][5]. Therefore, identifying more risk factors and improving secondary prevention have become a crucial issue of worldwide concern.…”

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

“…The 24 included studies were critically appraised by two independent reviewers using the JBI checklist. Of the 22 cohort studies (maximum quality score 11), 15 studies were assigned a score of 9 (Borzecki et al, 2016;Cheung et al, 2018;Dharmarajan et al, 2013;Dodson et al, 2019;Hess et al, 2016;Khera et al, 2017;Li et al, 2019;Litovchik et al, 2019;Mahmoud & Elgendy, 2018;McHugh & Ma, 2013;McManus et al, 2016;Meadows et al, 2012;Przybysz-Zdunek et al, 2012;Southern et al, 2014;Zabawa et al, 2018), five studies scored 11 (Dreyer et al, 2015;Kociol et al, 2012;Rodriguez et al, 2011;Tripathi et al, 2017Tripathi et al, , 2019 and the remaining studies scored 10 (Nuti et al, 2016) and 6 (Atti et al, 2019), respectively. The RCT studies scored 10 (maximum quality score 13) (Cajanding, 2017).…”

“…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).…”