Heart-attack patients in the US more likely to be readmitted to the hospital than other countries

January 03, 2012

CHICAGO - In an analysis of data from more than 15 countries that included the U.S., Canada, Australia, and many European nations, patients in the U.S. who experienced a ST-segment elevation myocardial infarction (STEMI; a certain pattern on an electrocardiogram following a heart attack) were more likely to be readmitted to the hospital at 30 days after the heart attack than patients in other countries, according to a study in the January 4 issue of JAMA.

Heart attack with ST-segment elevation accounts for 29 percent to 38 percent of all heart attacks. "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 postdischarge hospital readmission," according to background information in the article. "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., of Duke University Medical Center, Durham, N.C., and colleagues analyzed data from the Assessment of Pexelizumab in Acute Myocardial Infarction study, a large multinational clinical trial, to determine international variation in and predictors of 30-day readmission rates after STEMI and country-level care patterns. The trial enrolled 5,745 patients with STEMI at 296 sites in the United States, Canada, Australia, New Zealand, and 13 European countries from July 2004 to May 2006. Analysis was performed to identify predictors of all-cause and nonelective 30-day postdischarge hospital readmission.

Of the patients enrolled in the trial, there were 5,571 (97.0 percent) included in the analysis who survived to hospital discharge and represented 17 countries; 631 (11.3 percent) were readmitted within 30 days from hospital discharge. The researchers found that factors associated with 30-day readmission were multivessel coronary artery disease, U.S. enrollment (vs. rest of the world), and baseline heart rate. Patients with multivessel disease had almost twice the odds of readmission compared with those without; patients in the United States had a 68 percent increased odds of readmission vs. those outside the United States; and baseline heart rate per 10/min increase was associated with a 9 percent increased odds of readmission.

Thirty-day readmission rates were higher for the United States than other countries (14.5 percent vs. 9.9 percent). Median (midpoint) length of stay was shortest for U.S. patients (3 days) and longest for patients in Germany (8 days).

"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 nonelective readmission. Location in the United States was not a predictor of in-hospital death or 30-day postadmission death," the authors write.

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

The authors write that the finding that STEMI patients in the United States have a higher likelihood of 30-day all-cause hospital readmission may be related to differential rates of early readmission for elective revascularization and shorter median length of stay (LOS) in the United States. "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."

"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."
(JAMA. 2012;307[1]:66-74. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

To contact corresponding author Manesh R. Patel, M.D., call Sarah Avery at 919-660-1306 or email sarah.avery@duke.edu.

The JAMA Network Journals

Related Heart Attack Articles from Brightsurf:

Top Science Tip Sheet on heart failure, heart muscle cells, heart attack and atrial fibrillation results
Newly discovered pathway may have potential for treating heart failure - New research model helps predict heart muscle cells' impact on heart function after injury - New mass spectrometry approach generates libraries of glycans in human heart tissue - Understanding heart damage after heart attack and treatment may provide clues for prevention - Understanding atrial fibrillation's effects on heart cells may help find treatments - New research may lead to therapy for heart failure caused by ICI cancer medication

Molecular imaging identifies link between heart and kidney inflammation after heart attack
Whole body positron emission tomography (PET) has, for the first time, illustrated the existence of inter-organ communication between the heart and kidneys via the immune system following acute myocardial infarction.

Muscle protein abundant in the heart plays key role in blood clotting during heart attack
A prevalent heart protein known as cardiac myosin, which is released into the body when a person suffers a heart attack, can cause blood to thicken or clot--worsening damage to heart tissue, a new study shows.

New target identified for repairing the heart after heart attack
An immune cell is shown for the first time to be involved in creating the scar that repairs the heart after damage.

Heart cells respond to heart attack and increase the chance of survival
The heart of humans and mice does not completely recover after a heart attack.

A simple method to improve heart-attack repair using stem cell-derived heart muscle cells
The heart cannot regenerate muscle after a heart attack, and this can lead to lethal heart failure.

Mount Sinai discovers placental stem cells that can regenerate heart after heart attack
Study identifies new stem cell type that can significantly improve cardiac function.

Fixing a broken heart: Exploring new ways to heal damage after a heart attack
The days immediately following a heart attack are critical for survivors' longevity and long-term healing of tissue.

Heart patch could limit muscle damage in heart attack aftermath
Guided by computer simulations, an international team of researchers has developed an adhesive patch that can provide support for damaged heart tissue, potentially reducing the stretching of heart muscle that's common after a heart attack.

How the heart sends an SOS signal to bone marrow cells after a heart attack
Exosomes are key to the SOS signal that the heart muscle sends out after a heart attack.

Read More: Heart Attack News and Heart Attack Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.