Higher Readmission Among U.S. Heart Attack Patients
Jan 04, 2012 |
A study to determine predictors of 30-day readmission rates after a ST-segment elevation myocardial infarction (STEMI), revealed that heart attack patients in the U.S are more likely to be readmitted to the hospital at 30 days than patients in other countries.
The study, published in JAMA, analyzed data from 17 countries: 13 European countries, the United States, Canada, Australia and New Zealand. Heart attacks with ST-segment elevation account for 29% to 38% of all heart attacks.
Of the patients enrolled in the trial, 11.3% were readmitted within a month of being discharged from the hospital. Some of the factors associated with this readmission were multivessel coronary artery disease, baseline heart rate and U.S. enrollment. Other predictors of readmission included recurrent ischemia, chronic obstructive pulmonary disease, chronic inflammatory conditions, and a history of hypertension.
For heart attack patients in the U.S., 14.5% were readmitted within 30 days. However, only 9.9% were readmitted in other countries.
“Excluding elective readmission for revascularization, U.S. enrollment was still an independent predictor of readmission,” the authors write. “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 U.S. had the shortest median length of stay for patients at only three days and Germany had the longest median stay at eight days. This shorter median stay is one of the reasons the authors believe U.S. STEMI patients have a higher likelihood of 30-day readmission.
However, the authors also believe that the data shows this is one area that the U.S. can definitely improve if the statistics for other countries is anything to go by.
"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,” the authors write. “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.”