Luis Rodriguez-Padial1, Francisco J Elola2, Cristina Fernández-Pérez3, José L Bernal4, Andrés Iñiguez5, José V Segura6, Vicente Bertomeu7. 1. Cardiac Unit, Complejo Hospitalario de Toledo, Spain. Electronic address: lrpadial@gmail.com. 2. Foundation Institute for Healthcare Improvement, Madrid, Spain. 3. Foundation Institute for Healthcare Improvement, Madrid, Spain; Hospital Clínico Universitario San Carlos, Universidad Complutense de Madrid, Spain. 4. Foundation Institute for Healthcare Improvement, Madrid, Spain; Control Management Service, 12 de Octubre Hospital, Madrid, Spain. 5. Cardiac Unit, Complejo Hospitalario de Vigo, Spain. 6. Foundation Institute for Healthcare Improvement, Madrid, Spain; IUI Operative Research Center, Miguel Hernández University, Alicante, Spain. 7. Foundation Institute for Healthcare Improvement, Madrid, Spain; Cardiac Unit, Hospital San Juan, Universidad Miguel Hernández, Alicante, Spain.
Abstract
BACKGROUND: Acute myocardial infarction (AMI) is a common cause of hospital discharges and readmissions. Readmissions may indicate poor patient care and avoidable health expenditure, being key in quality improvement strategies. Our aim was to analyse cardiac diseases (CDs) readmissions in patients with AMI in Spain. METHODS: A retrospective analysis of 33,538 hospital discharges with AMI being the "principal diagnosis" at hospitals of the Spanish National Health System in 2012 was performed using administrative data. We developed a logistic regression model and calculated 30-day, 3-month and 1-year CDs risk-standardized readmission rates (RSRRs) using a multivariate mixed model. RESULTS: Variables of the model (AMI location, age, previous angina pectoris/myocardial infarction or acute coronary syndrome, chronic kidney disease, rheumatic valvular disease, diabetes mellitus, vascular disease, female sex, chronic pulmonary disease, and anemia) were able to predict 30-day, 3-month and 1-year readmission rates and RSRRs after AMI (5.4%, 9.3% and 20.2%, respectively). For RSRRs the area under the ROC curve was 0.74 (p=0.0037), 0.77 (p=0.0041), and 0.73 (p=0.0025) for 1, 3months and 1-year readmission rate, respectively. Angioplasty, cardiology as the medical unit responsible for the discharge and a higher volume of activity (>204 AMI) were all significantly (p<0.001) associated with lower mortality, risk of development of heart failure and RSRRs. CONCLUSIONS: Angioplasty, cardiology as the medical unit responsible for the discharge and a higher volume of activity explain variability in CDs readmission rates after AMI, which can have implications for strategies to reduce readmissions rates.
BACKGROUND:Acute myocardial infarction (AMI) is a common cause of hospital discharges and readmissions. Readmissions may indicate poor patient care and avoidable health expenditure, being key in quality improvement strategies. Our aim was to analyse cardiac diseases (CDs) readmissions in patients with AMI in Spain. METHODS: A retrospective analysis of 33,538 hospital discharges with AMI being the "principal diagnosis" at hospitals of the Spanish National Health System in 2012 was performed using administrative data. We developed a logistic regression model and calculated 30-day, 3-month and 1-year CDs risk-standardized readmission rates (RSRRs) using a multivariate mixed model. RESULTS: Variables of the model (AMI location, age, previous angina pectoris/myocardial infarction or acute coronary syndrome, chronic kidney disease, rheumatic valvular disease, diabetes mellitus, vascular disease, female sex, chronic pulmonary disease, and anemia) were able to predict 30-day, 3-month and 1-year readmission rates and RSRRs after AMI (5.4%, 9.3% and 20.2%, respectively). For RSRRs the area under the ROC curve was 0.74 (p=0.0037), 0.77 (p=0.0041), and 0.73 (p=0.0025) for 1, 3months and 1-year readmission rate, respectively. Angioplasty, cardiology as the medical unit responsible for the discharge and a higher volume of activity (>204 AMI) were all significantly (p<0.001) associated with lower mortality, risk of development of heart failure and RSRRs. CONCLUSIONS: Angioplasty, cardiology as the medical unit responsible for the discharge and a higher volume of activity explain variability in CDs readmission rates after AMI, which can have implications for strategies to reduce readmissions rates.
Authors: Lauren N Smith; Anil N Makam; Douglas Darden; Helen Mayo; Sandeep R Das; Ethan A Halm; Oanh Kieu Nguyen Journal: Circ Cardiovasc Qual Outcomes Date: 2018-01
Authors: Rachel P Dreyer; Valeria Raparelli; Sui W Tsang; Gail D'Onofrio; Nancy Lorenze; Catherine F Xie; Mary Geda; Louise Pilote; Terrence E Murphy Journal: J Am Heart Assoc Date: 2021-09-13 Impact factor: 5.501