Heart Attack Hospital Re-Admission Rates Higher In The USA Than Abroad

Editor's Choice
Academic Journal
Main Category: Heart Disease
Also Included In: Cardiovascular / Cardiology
Article Date: 06 Jan 2012 - 7:00 PST


A study published in the January 4 issue of JAMA shows that U.S. patients who experienced a ST-segment elevation myocardial infarction (STEMI), a certain pattern on an electrocardiogram after a heart attack, were more likely to be readmitted to the hospital at 30 days after the heart attack compared with patients in other countries. The findings were discovered during a data analysis from over 15 countries, including the U.S., Canada, Australia, and many European nations.

Approximately 29 to 38% of all heart attacks are due to ST-segment elevation. Background information in the article states that:

"In the present era of primary percutaneous coronary intervention [PCI; procedures such as balloon angioplasty or stent placement used to open narrowed coronary arteries], survival to hospital discharge has improved dramatically. Subsequently, patients who survive to hospital discharge are at risk for early post-discharge hospital readmission. Recently, 30-day readmission rates have been proposed as a metric for care of patients with STEMI. However, international rates and predictors of 30-day readmission after STEMI have not been studied."

Robb D. Kociol, M.D., from the Duke University Medical Center in Durham, N.C., and his team evaluated data from a large multinational clinical trial, (the Assessment of Pexelizumab in Acute Myocardial Infarction study) to establish international variation in and predictors of 30-day readmission rates after STEMI and country-level care patterns. From July 2004 to May 2006, the researchers recruited 5,745 patients with STEMI at 296 sites in the United States, Canada, Australia, New Zealand, as well as from 13 European countries and conducted an evaluation to ascertain predictors of all-cause and 30-day post-discharge hospital readmission that was non-elective.

From the total number of participants, 5,571 or 97% of patients who survived and were discharged from hospital from 17 countries, 631 or 11.3% were readmitted within 30 days of their hospital discharge.

According to the researchers, factors linked to 30-day readmission were multivessel coronary artery disease, U.S. enrollment in comparison to the rest of the world, and baseline heart rate. They established that patients with multivessel disease were almost twice as likely to be readmitted to hospital as those without the disease. Furthermore, patients in the U.S. had a 68% higher risk or readmission compared with those outside the U.S. In addition, U.S. patients' baseline heart rate per 10/min increase was linked to a 9% higher chance of readmission.

U.S. patients had a 14.5% higher rate of 30-day readmission compared with 9.9% of patients in other countries. The average midpoint length of 3 days hospital stay was the shortest for patients in the U.S., whilst patients in Germany had the longest stay of 8 days.

The researchers state:

"Excluding elective readmission for revascularization, U.S. enrollment was still an independent predictor of readmission. After adjustment of the models for country-level median length of stay, U.S. location was no longer an independent predictor of 30-day all-cause or non-elective readmission. Location in the United States was not a predictor of in-hospital death or 30-day post-admission death."

The researchers noted that other predictors of readmission included factors, such as recurrent ischemia, chronic inflammatory conditions, chronic obstructive pulmonary disease, as well as a history of hypertension.

According to the authors, the finding that U.S. STEMI patients tend to have a higher chance of 30-day all-cause hospital readmission may be associated with differential rates of early readmission for elective revascularization and shorter median length of stay (LOS) in the United States, saying:

"In particular, country-level median LOS 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."

They conclude:

"Significant attention has been focused on reducing acute myocardial infarction readmission rates in the United States as a means of reducing health care costs, according to the assumption that readmission is (at least in part) preventable. Our analysis shows that readmission may be preventable because rates are nearly one-third lower in other countries, suggesting that the U.S. health care system has features that can be modified to decrease readmission rates.

Understanding these international differences may provide important insight into reducing such rates, particularly in the United States."

Written by Petra Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

• Additional
• References
• Citations