BACKGROUND: Rehospitalization is a quality-of-care indicator, yet little is known about its occurrence and predictors after myocardial infarction (MI) in the community. OBJECTIVE: To examine 30-day rehospitalizations after incident MI. DESIGN: Retrospective cohort study. SETTING: Population-based registry in Olmsted County, Minnesota. PATIENTS: 3010 patients who were hospitalized in Olmsted County with first-ever MI from 1987 to 2010 and survived to hospital discharge. MEASUREMENTS: Diagnoses, therapies, and complications during incident and subsequent hospitalizations were identified. Manual chart review was performed to determine the cause of all rehospitalizations. The hazard ratios and cumulative incidence of 30-day rehospitalizations were determined by using Cox proportional hazards regression models. RESULTS: Among 3010 patients (mean age, 67 years; 40.5% female) with incident MI (31.2% ST-segment elevation), 643 rehospitalizations occurred within 30 days in 561 (18.6%) patients. Overall, 30.2% of rehospitalizations were unrelated to the incident MI and 42.6% were related; the relationship was unclear in 27.2% of rehospitalizations. Angiography was performed in 153 (23.8%) rehospitalizations. Revascularization was performed in 103 (16.0%) rehospitalizations, of which 46 (44.7%) had no revascularization during the index hospitalization. After adjustment for potential confounders, diabetes, chronic obstructive pulmonary disease, anemia, higher Killip class, longer length of stay during the index hospitalization, and a complication of angiography or reperfusion or revascularization were associated with increased rehospitalization risk. The 30-day incidence of rehospitalization was 35.3% in patients who experienced a complication of angiography during the index MI hospitalization and 31.6% in those who experienced a complication of reperfusion or revascularization during the index MI hospitalization, compared with 16.8% in patients who had reperfusion or revascularization without complications. LIMITATION: This study represents the experiences of a single community. CONCLUSION: Comorbid conditions, longer length of stay, and complications of angiography and revascularization or reperfusion are associated with increased 30-day rehospitalization risk after MI. Many rehospitalizations seem to be unrelated to the incident MI. PRIMARY FUNDING SOURCE: National Institutes of Health.
BACKGROUND: Rehospitalization is a quality-of-care indicator, yet little is known about its occurrence and predictors after myocardial infarction (MI) in the community. OBJECTIVE: To examine 30-day rehospitalizations after incident MI. DESIGN: Retrospective cohort study. SETTING: Population-based registry in Olmsted County, Minnesota. PATIENTS: 3010 patients who were hospitalized in Olmsted County with first-ever MI from 1987 to 2010 and survived to hospital discharge. MEASUREMENTS: Diagnoses, therapies, and complications during incident and subsequent hospitalizations were identified. Manual chart review was performed to determine the cause of all rehospitalizations. The hazard ratios and cumulative incidence of 30-day rehospitalizations were determined by using Cox proportional hazards regression models. RESULTS: Among 3010 patients (mean age, 67 years; 40.5% female) with incident MI (31.2% ST-segment elevation), 643 rehospitalizations occurred within 30 days in 561 (18.6%) patients. Overall, 30.2% of rehospitalizations were unrelated to the incident MI and 42.6% were related; the relationship was unclear in 27.2% of rehospitalizations. Angiography was performed in 153 (23.8%) rehospitalizations. Revascularization was performed in 103 (16.0%) rehospitalizations, of which 46 (44.7%) had no revascularization during the index hospitalization. After adjustment for potential confounders, diabetes, chronic obstructive pulmonary disease, anemia, higher Killip class, longer length of stay during the index hospitalization, and a complication of angiography or reperfusion or revascularization were associated with increased rehospitalization risk. The 30-day incidence of rehospitalization was 35.3% in patients who experienced a complication of angiography during the index MI hospitalization and 31.6% in those who experienced a complication of reperfusion or revascularization during the index MI hospitalization, compared with 16.8% in patients who had reperfusion or revascularization without complications. LIMITATION: This study represents the experiences of a single community. CONCLUSION: Comorbid conditions, longer length of stay, and complications of angiography and revascularization or reperfusion are associated with increased 30-day rehospitalization risk after MI. Many rehospitalizations seem to be unrelated to the incident MI. PRIMARY FUNDING SOURCE: National Institutes of Health.
Authors: S C Smith; J T Dove; A K Jacobs; J W Kennedy; D Kereiakes; M J Kern; R E Kuntz; J J Popma; H V Schaff; D O Williams; R J Gibbons; J P Alpert; K A Eagle; D P Faxon; V Fuster; T J Gardner; G Gregoratos; R O Russell; S C Smith Journal: Circulation Date: 2001-06-19 Impact factor: 29.690
Authors: A D White; A R Folsom; L E Chambless; A R Sharret; K Yang; D Conwill; M Higgins; O D Williams; H A Tyroler Journal: J Clin Epidemiol Date: 1996-02 Impact factor: 6.437
Authors: Andrew S Levey; Josef Coresh; Tom Greene; Lesley A Stevens; Yaping Lucy Zhang; Stephen Hendriksen; John W Kusek; Frederick Van Lente Journal: Ann Intern Med Date: 2006-08-15 Impact factor: 25.391
Authors: Charanjit S Rihal; Stephen C Textor; Diane E Grill; Peter B Berger; Henry H Ting; Patricia J Best; Mandeep Singh; Malcolm R Bell; Gregory W Barsness; Verghese Mathew; Kirk N Garratt; David R Holmes Journal: Circulation Date: 2002-05-14 Impact factor: 29.690
Authors: Wayne L Miller; Kirk N Garratt; Mary F Burritt; Ryan J Lennon; Guy S Reeder; Allan S Jaffe Journal: Eur Heart J Date: 2006-02-15 Impact factor: 29.983
Authors: Earl S Ford; Umed A Ajani; Janet B Croft; Julia A Critchley; Darwin R Labarthe; Thomas E Kottke; Wayne H Giles; Simon Capewell Journal: N Engl J Med Date: 2007-06-07 Impact factor: 91.245
Authors: Mayra Tisminetzky; David D McManus; Nathaniel Erskine; Jane S Saczynski; Jorge Yarzebski; Edgard Granillo; Joel Gore; Robert J Goldberg Journal: Am J Med Date: 2015-02-03 Impact factor: 4.965
Authors: William S Weintraub; Zaher Fanari; Daniel Elliott; Jennifer Ostertag-Stretch; Ann Muther; Margaret Lynahan; Roger Kerzner; Tabassum Salam; Herbert Scherrer; Sharon Anderson; Carla A Russo; Paul Kolm; Terri H Steinberg Journal: Cardiovasc Revasc Med Date: 2017-07-03
Authors: Mayra Tisminetzky; Jerry H Gurwitz; Ruben Miozzo; Joel M Gore; Darleen Lessard; Jorge Yarzebski; Robert J Goldberg Journal: Am J Cardiol Date: 2019-08-08 Impact factor: 2.778
Authors: Ziv Harel; Ron Wald; Eric McArthur; Glenn M Chertow; Shai Harel; Andrea Gruneir; Hadas D Fischer; Amit X Garg; Jeffrey Perl; Danielle M Nash; Samuel Silver; Chaim M Bell Journal: J Am Soc Nephrol Date: 2015-04-08 Impact factor: 10.121
Authors: Sheila M Manemann; Alanna M Chamberlain; Cynthia M Boyd; Donna M Miller; Kimberly L Poe; Andrea Cheville; Susan A Weston; Ellen E Koepsell; Ruoxiang Jiang; Véronique L Roger Journal: Circ Cardiovasc Qual Outcomes Date: 2018-08
Authors: Kumar Dharmarajan; Angela F Hsieh; Zhenqiu Lin; Héctor Bueno; Joseph S Ross; Leora I Horwitz; José Augusto Barreto-Filho; Nancy Kim; Susannah M Bernheim; Lisa G Suter; Elizabeth E Drye; Harlan M Krumholz Journal: JAMA Date: 2013-01-23 Impact factor: 56.272