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US Heart Attack Patients Have Elevated Hospital Readmission Rates

US Heart Attack Patients Have Elevated Hospital Readmission RatesPatients in the US who have had a type of heart attack known as an ST-segment elevation myocardial infarction (STEMI) are more likely to be readmitted to the hospital within 30 days of discharge than patients in a number of other countries, researchers have found.
 
Roughly a third of heart attacks are STEMIs, in which blood supply to the heart is cut off for a prolonged period of time, resulting in significant damage to the heart muscle and marked changes in a post–heart attack electrocardiogram. Reducing hospital readmission rates for STEMI patients has been proposed as a way of reducing health care costs.
 
For the current study, researchers used data from the Assessment of Pexelizumab in Acute Myocardial Infarction study, which enrolled 5,745 patients with STEMI in the US, Canada, Australia, New Zealand, and 13 European countries from 2004 to 2006.
 
Of the 5,571 patients who survived to hospital discharge, 631 (11.3%) were readmitted within 30 days of discharge. Patients with multivessel coronary artery disease were twice as likely to be readmitted within 30 days; patients in the US were 68% more likely to be readmitted; and patients with elevated baseline heart rate were 9% more likely to be readmitted for every 10 beats per minute increase. Even when elective readmission for revascularization was excluded, US patients were still 53% more likely to be readmitted within 30 days.
 
The 30-day readmission rate was 14.5% for US patients compared with 9.9% for patients in the other 16 countries, but the median length of stay in the hospital was shortest, at three days, for US patients. (Germany had the longest median length of stay, at eight days.) The researchers point out that the higher likelihood of readmission in the US may be due to this shorter median length of stay.
 
Nonetheless, the researchers argue that their findings back up the notion that it might be possible to reduce US health care costs by reducing hospital readmission rates for STEMI patients. “Our analysis shows that readmission may be preventable because rates are nearly one-third lower in other countries, suggesting that the US health care system has features that can be modified to decrease readmission rates,” they write, according to a press release. “Understanding these international differences may provide important insight into reducing such rates, particularly in the United States."
 
The study appears in the January 4 edition of JAMA.

Further Reading
Evidence-based therapies are increasingly being used to treat patients with ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction, according to research published in the Feb. 1 issue of The American Journal of Cardiology.
For patients with ST-segment elevation myocardial infarction, high-sensitivity C-reactive protein measurements at presentation predict subsequent nonfatal myocardial infarction and cardiac death; and for patients with acute coronary syndromes, fetuin-A and C-reactive protein have prognostic value, according to two studies published in the Jan. 1 issue of The American Journal of Cardiology.
New guidelines urge timely management for patients with ST-segment elevation myocardial infarction, according to a scientific report co-published online Dec. 17 in Circulation and the Journal of the American College of Cardiology.
Trial results presented at ACC.14 demonstrated that treatment with metformin immediately after PCI in non-diabetic patients presenting with acute STEMI does not lead to improvements in left ventricular ejection fraction or other measure of cardiac function.
A recent study of thienopyridine use among patients who had undergone percutaneous coronary intervention (PCI) in a large hospital network found that the antiplatelet drug ticagrelor was more frequently prescribed in higher risk, less stable patients.
In patients undergoing primary angioplasty for ST-segment elevation myocardial infarction, diabetes is associated with worse long-term outcomes, including mortality, reinfarction, stent thrombosis, and target vessel revascularization, according to research published online Dec. 28 in Diabetes Care.
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