Document Detail

International variation in and factors associated with hospital readmission after myocardial infarction.
MedLine Citation:
PMID:  22215167     Owner:  NLM     Status:  MEDLINE    
CONTEXT: ST-segment elevation myocardial infarction (STEMI) treatment has improved outcomes and shortened hospital stay. 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.
OBJECTIVE: To determine international variation in and predictors of 30-day readmission rates after STEMI and country-level care patterns.
DESIGN, SETTING, AND PATIENTS: Post hoc analysis of the Assessment of Pexelizumab in Acute Myocardial Infarction trial that enrolled 5745 patients with STEMI at 296 sites in the United States, Canada, Australia, New Zealand, and 13 European countries from July 13, 2004, to May 11, 2006. Multivariable logistic regression analysis was used to identify independent predictors of all-cause and nonelective 30-day postdischarge readmission.
MAIN OUTCOME MEASURES: Predictors of 30-day postdischarge all-cause and nonelective readmissions.
RESULTS: Of 5571 patients with STEMI who survived to hospital discharge, 631 (11.3%) were readmitted within 30 days. Thirty-day readmission rates were higher for the United States than other countries (14.5% vs 9.9%; P < .001). Median length of stay was shortest for US patients (3 days; interquartile range, 2-4 days) and longest for Germany (8 days; interquartile range, 6-11 days). In multivariable regression, the predictors of 30-day readmission included multivessel disease (odds ratio [OR], 1.97; 95% CI, 1.65-2.35) and US location (OR, 1.68; 95% CI, 1.37-2.07). Excluding elective readmission for revascularization, US enrollment was still an independent predictor of readmission (OR, 1.53; 95% CI, 1.20-1.96). After adjustment of the models for country-level median length of stay, US 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, 0.88; 95% CI, 0.60-1.30) or 30-day postadmission death (OR, 1.0; 95% CI, 0.72-1.39).
CONCLUSIONS: In this multinational study, there was variation across countries in 30-day readmission rates after STEMI, with readmission rates higher in the United States than in other countries. However, this difference was greatly attenuated after adjustment for length of stay.
Robb D Kociol; Renato D Lopes; Robert Clare; Laine Thomas; Rajendra H Mehta; Padma Kaul; Karen S Pieper; Judith S Hochman; W Douglas Weaver; Paul W Armstrong; Christopher B Granger; Manesh R Patel
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JAMA     Volume:  307     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-01-04     Completed Date:  2012-01-06     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  66-74     Citation Subset:  AIM; IM    
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MeSH Terms
Australia / epidemiology
Canada / epidemiology
Europe / epidemiology
Hospital Mortality
Length of Stay / statistics & numerical data*
Middle Aged
Myocardial Infarction / therapy*
New Zealand / epidemiology
Outcome Assessment (Health Care)
Patient Discharge
Patient Readmission / statistics & numerical data*
Randomized Controlled Trials as Topic
Risk Factors
United States / epidemiology
Comment In:
JAMA. 2012 Apr 25;307(16):1690-1; author reply 1691   [PMID:  22535848 ]
JAMA. 2012 Apr 25;307(16):1690; author reply 1691   [PMID:  22535847 ]

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