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Readmission after STEMI likelier in U.S. than elsewhere

Tuesday January 3, 2012
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Patients in the United States who experienced a ST-segment elevation myocardial infarction were more likely to be readmitted to the hospital at 30 days after the attack than patients in other countries, according to an analysis of data from more than 15 nations.

Myocardial infarction with ST-segment elevation accounts for 29% to 38% of all MI cases, according to information in the study, which appears in the Jan. 4 issue of JAMA. "In the present era of primary percutaneous coronary intervention, survival to hospital discharge has improved dramatically," the authors wrote. "Subsequently, patients who survive to hospital discharge are at risk for early post-discharge hospital readmission."

The authors noted that 30-day readmission rates have been proposed as a metric for care of patients with STEMI, but studies have not examined international rates and predictors of 30-day readmission after STEMI.

Robb D. Kociol, MD, and colleagues with Duke University Medical Center in Durham, N.C., analyzed data from a trial consisting of 5,745 patients with STEMI at 296 sites in the U.S., Canada, Australia, New Zealand, and 13 European countries from July 2004 to May 2006. Analysis was performed to identify predictors of all-cause and non-elective 30-day post-discharge hospital readmission. The researchers sought to determine international variation in and predictors of 30-day readmission rates after STEMI, and country-level care patterns.

The researchers found that factors associated with 30-day readmission were multi-vessel coronary artery disease, U.S. enrollment (vs. rest of the world), and baseline heart rate. Patients with multi-vessel disease had almost twice the odds of readmission compared with those without; patients in the U.S. had 68% increased odds of readmission vs. those in other countries; and increase in baseline heart rate was associated with 9% increased odds of readmission.

Thirty-day readmission rates were higher for the United States than other countries (14.5% vs. 9.9%). Median length of stay was shortest for U.S. patients (three days) and longest for patients in Germany (eight days).

Those two findings might be related, the authors wrote: "In particular, country-level median LOS [length of stay] attenuates the relationship between the United States and early readmission. Further research is needed to better understand the relationship between LOS and readmission rates and define and optimize overall efficiency of care internationally."

After adjusting their analytical models for country-level median length of stay, the authors found that U.S. location was no longer an independent predictor of 30-day all-cause or non-elective readmission. Location in the U.S. was not a predictor of in-hospital death or 30-day post-admission death.

Other predictors of readmission included recurrent ischemia, chronic obstructive pulmonary disease, chronic inflammatory conditions and a history of hypertension.

To read a study summary and access the study via subscription or purchase, visit http://bit.ly/AzgzC7.


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