Type 2 Myocardial Infarction and the Hospital Readmission Reduction Program

McCarthy, Cian P.; Vaduganathan, Muthiah; Singh, Avinainder; Song, Zirui; Blankstein, Ron; Gaggin, Hanna K.; Wasfy, Jason H.; Januzzi, James L.

doi:10.1016/j.jacc.2018.06.055

Cited by 20 publications

(16 citation statements)

References 14 publications

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“…Type 2 MI also includes the aforementioned symptoms, but is due to a supply‐demand mismatch of myocardial oxygen in the absence of coronary thrombosis 7,8 . Prior to 2017, differentiating patients with type 1 and type 2 MI‐based via medical coding was not possible because an ICD code for each particular MI subtype did not exist 8 . Without strict ICD 10 coding criteria and an effective means of determining the specific type of MI at bedside and given that patients with type 2 MI can potentially have numerous underlying comorbidities, a type 2 diagnosis is subject to uncertainty or misdiagnosis.…”

Section: Distinguishing Differences In MI Classificationmentioning

confidence: 99%

“…Without strict ICD 10 coding criteria and an effective means of determining the specific type of MI at bedside and given that patients with type 2 MI can potentially have numerous underlying comorbidities, a type 2 diagnosis is subject to uncertainty or misdiagnosis. An estimated 90% of type 2 MI patients were not being coded 8,9 . An ICD code now exists for type 2 MI, yet issues still surround accurately documenting other forms of type 1 MI as type 2 MI.…”

Section: Distinguishing Differences In MI Classificationmentioning

confidence: 99%

“…Acute MI is one of six conditions included in the HRRP, with a combined total of $528 million being withheld from hospitals due to readmissions in 2017 8 . Of all readmitted patients with MI contributing to the HRRP penalty, about 10% may have actually had type 2 MI 8,11 . In conjunction with the Hospital Value‐Based Purchasing Program, and after strict adjudication with physician medical record reviewers using the most current universal definition of MI, 7 McCarthy et al found that approximately 41% of patients with nonischemic myocardial injury are frequently misdiagnosed and subsequently billed as having type 2 MI 10 .…”

Section: Distinguishing Differences In MI Classificationmentioning

confidence: 99%

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Myocardial infarction classification and its implications on measures of cardiovascular outcomes, quality, and racial/ethnic disparities

Hilliard

Winchester

Russell

et al. 2020

Clinical Cardiology

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Heart disease continues to be the leading cause of death in the United States, with approximately 805 000 cumulative deaths from myocardial infarctions (MI) from 2005 to 2014. Gender and racial/ethnic disparities in MI diagnoses are becoming more evident in quality review audits. Although recent changes in diagnostic codes provided an improved framework, clinically distinguishing types of MI remains a challenge. MI misdiagnoses and health disparities contribute to adverse outcomes in cardiac medicine. We conducted a literature review of relevant biomedical sources related to the classification of MI and disparities in cardiovascular care and outcomes. From the studies analyzed, African Americans and women have higher rates of mortality from MI, are more probably to be younger and present with other comorbidities and are less probably to receive novel therapies with respect to type of MI. As highsensitivity troponin assays are adopted in the United States, implementation should account for how race and sex differences have been demonstrated in the reference range and diagnostic threshold of the newer assays. More research is needed to assess how the complexity of health disparities contributes to adverse cardiovascular outcomes. Creating dedicated medical quality teams (physicians, nurses, clinical documentation improvement specialists, and medical coders) and incorporating a plan-docheck-adjust quality improvement model are strategies that could potentially help better define and diagnose MI, reduce financial burdens due to MI misdiagnoses, reduce cardiovascular-related health disparities, and ultimately improve and save lives. K E Y W O R D S cardiac, diagnostic codes, international statistical classification of diseases ICD 10, myocardial injury, myocardial infarction < ischemic heart disease, plan-do-check-adjust, quality improvement, troponin

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Section: Distinguishing Differences In MI Classificationmentioning

confidence: 99%

Section: Distinguishing Differences In MI Classificationmentioning

confidence: 99%

Section: Distinguishing Differences In MI Classificationmentioning

confidence: 99%

See 1 more Smart Citation

Myocardial infarction classification and its implications on measures of cardiovascular outcomes, quality, and racial/ethnic disparities

Hilliard

Winchester

Russell

et al. 2020

Clinical Cardiology

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“…However, patients with type 2 MI may now be more prevalent than patients with type 1 MI, and they have higher 30-day readmission rates than patients with type 1 MI (20% vs 15%). 5,6 Therefore, they likely represent a significant portion of patients with excess readmissions contributing to the HRRP. Patients with type 2 MI are commonly readmitted due to noncardiovascular ailments.…”

Section: Myocardial Infarction and Value-based Programs The Hospital mentioning

confidence: 99%

“…This represents a substantial divergence from the evidence-based treatment strategies that reduce readmissions for patients with type 1 MI. 6…”

Section: Myocardial Infarction and Value-based Programs The Hospital mentioning

confidence: 99%

Type 2 Myocardial Infarction and Value-Based Programs: Cutting the Supply in the Absence of Demand

McCarthy

2019

The American Journal of Medicine

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Misclassification of Myocardial Injury as Myocardial Infarction

et al. 2019

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IMPORTANCE Similar to other patients with acute myocardial infarction, patients with type 2 myocardial infarction (T2MI) are included in several value-based programs, including the Hospital Readmissions Reduction Program and the Hospital Value-Based Purchasing Program. To our knowledge, whether nonischemic myocardial injury is being misclassified as T2MI is unknown and may have implications for these programs. OBJECTIVE To determine whether patients with nonischemic myocardial injury are being miscoded as having T2MI and if this has implications for 30-day readmission and mortality rates. DESIGN, SETTINGS, AND PARTICIPANTS Using the new International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code, we identified patients who were coded as having T2MI between October 2017 and May 2018 at Massachusetts General Hospital. Strict adjudication using the fourth universal definition of MI was then applied. MAIN OUTCOME AND MEASURES Clinical adjudication of T2MI and 30-day readmission and mortality rates as a function of T2MI or nonischemic myocardial injury. RESULTS Of 633 patients, 369 (58.3%) were men and 514 (81.2%) were white. After strict adjudication, 359 (56.7%) had T2MI, 265 (41.9%) had myocardial injury, 6 (0.9%) had type 1 MI, and 3 (0.5%) had unstable angina. Patients with T2MI had a higher prevalence of cardiovascular comorbidities than those with myocardial injury. Patients with T2MI and myocardial injury had high in-hospital mortality rates (10.6% and 8.7%, respectively; P = .50). Of those discharged alive (563 [88.9%]), 30-day readmission rates (22.7% vs 21.1%; P = .68) and mortality rates (4.4% vs 7.4%; P = .14) were comparable among patients with T2MI and myocardial injury. CONCLUSIONS AND RELEVANCE A substantial percentage of patients coded as having T2MI actually have myocardial injury. Both conditions have high 30-day readmission and mortality rates. Including patients with high-risk myocardial injury may have substantial implications for value-based programs.

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Type 2 Myocardial Infarction and the Hospital Readmission Reduction Program

Cited by 20 publications

References 14 publications

Myocardial infarction classification and its implications on measures of cardiovascular outcomes, quality, and racial/ethnic disparities

Myocardial infarction classification and its implications on measures of cardiovascular outcomes, quality, and racial/ethnic disparities

Type 2 Myocardial Infarction and Value-Based Programs: Cutting the Supply in the Absence of Demand

Misclassification of Myocardial Injury as Myocardial Infarction

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