International Variation in and Factors Associated With Hospital Readmission After Myocardial Infarction
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 hav...
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| creator | Kociol, Robb D Lopes, Renato D Clare, Robert Thomas, Laine Mehta, Rajendra H Kaul, Padma Pieper, Karen S Hochman, Judith S Weaver, W. Douglas Armstrong, Paul W Granger, Christopher B Patel, Manesh R |
| description | 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 |
| doi_str_mv | 10.1001/jama.2011.1926 |
| format | Article |
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Douglas ; Armstrong, Paul W ; Granger, Christopher B ; Patel, Manesh R</creator><creatorcontrib>Kociol, Robb D ; Lopes, Renato D ; Clare, Robert ; Thomas, Laine ; Mehta, Rajendra H ; Kaul, Padma ; Pieper, Karen S ; Hochman, Judith S ; Weaver, W. Douglas ; Armstrong, Paul W ; Granger, Christopher B ; Patel, Manesh R</creatorcontrib><description>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.</description><identifier>ISSN: 0098-7484</identifier><identifier>EISSN: 1538-3598</identifier><identifier>DOI: 10.1001/jama.2011.1926</identifier><identifier>PMID: 22215167</identifier><identifier>CODEN: JAMAAP</identifier><language>eng</language><publisher>Chicago, IL: American Medical Association</publisher><subject>Aged ; Australia - epidemiology ; Biological and medical sciences ; Canada - epidemiology ; Cardiology. Vascular system ; Coronary heart disease ; Europe - epidemiology ; Female ; Forecasting ; General aspects ; Heart ; Heart attacks ; Hospital Mortality ; Humans ; Internationality ; Length of Stay - statistics & numerical data ; Male ; Medical sciences ; Middle Aged ; Miscellaneous ; Myocardial Infarction - therapy ; New Zealand - epidemiology ; Outcome Assessment (Health Care) ; Patient admissions ; Patient Discharge ; Patient Readmission - statistics & numerical data ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Randomized Controlled Trials as Topic ; Risk Factors ; United States - epidemiology</subject><ispartof>JAMA : the journal of the American Medical Association, 2012-01, Vol.307 (1), p.66-74</ispartof><rights>2015 INIST-CNRS</rights><rights>Copyright American Medical Association Jan 4, 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a410t-d3cb81169f4f52ab31c31db33087bdaf56ee79df363bf544d9b4dae2dead31393</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jama/articlepdf/10.1001/jama.2011.1926$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2011.1926$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,314,780,784,3340,27924,27925,76489,76492</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25576904$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22215167$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kociol, Robb D</creatorcontrib><creatorcontrib>Lopes, Renato D</creatorcontrib><creatorcontrib>Clare, Robert</creatorcontrib><creatorcontrib>Thomas, Laine</creatorcontrib><creatorcontrib>Mehta, Rajendra H</creatorcontrib><creatorcontrib>Kaul, Padma</creatorcontrib><creatorcontrib>Pieper, Karen S</creatorcontrib><creatorcontrib>Hochman, Judith S</creatorcontrib><creatorcontrib>Weaver, W. Douglas</creatorcontrib><creatorcontrib>Armstrong, Paul W</creatorcontrib><creatorcontrib>Granger, Christopher B</creatorcontrib><creatorcontrib>Patel, Manesh R</creatorcontrib><title>International Variation in and Factors Associated With Hospital Readmission After Myocardial Infarction</title><title>JAMA : the journal of the American Medical Association</title><addtitle>JAMA</addtitle><description>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.</description><subject>Aged</subject><subject>Australia - epidemiology</subject><subject>Biological and medical sciences</subject><subject>Canada - epidemiology</subject><subject>Cardiology. Vascular system</subject><subject>Coronary heart disease</subject><subject>Europe - epidemiology</subject><subject>Female</subject><subject>Forecasting</subject><subject>General aspects</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Internationality</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Miscellaneous</subject><subject>Myocardial Infarction - therapy</subject><subject>New Zealand - epidemiology</subject><subject>Outcome Assessment (Health Care)</subject><subject>Patient admissions</subject><subject>Patient Discharge</subject><subject>Patient Readmission - statistics & numerical data</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Risk Factors</subject><subject>United States - epidemiology</subject><issn>0098-7484</issn><issn>1538-3598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkc1r3DAQxUVpabbbXnvooZhAyclbjUeyreMSmmYhJVD6cTRjfbRavNZW8h7y30fubhKIdJBgfu_NMI-x98BXwDl83tKOVhUHWIGq6hdsARLbEqVqX7IF56otG9GKM_YmpS3PB7B5zc6qqgIJdbNgfzbjZONIkw8jDcUviv7_v_BjQaMprkhPIaZinVLQuWRN8dtPf4vrkPZ-yorvlszOpzRr1i57Fd_ugqZofC5uRkdRz35v2StHQ7LvTu-S_bz68uPyury5_bq5XN-UJIBPpUHdtwC1csLJinoEjWB6RN42vSEna2sbZRzW2DsphFG9MGQrk6dAQIVLdnH03cfw72DT1OXhtB0GGm04pE6BQM6FrDN5_ozchkPexDBDTV2hzHfJVkdIx5BStK7bR7-jeNcB7-YAujmAbg6gmwPIgo8n10O_s-YRf9h4Bj6dAEqaBhdp1D49cVI2teIicx-O3Oz_2BQ4KiXxHn00l74</recordid><startdate>20120104</startdate><enddate>20120104</enddate><creator>Kociol, Robb D</creator><creator>Lopes, Renato D</creator><creator>Clare, Robert</creator><creator>Thomas, Laine</creator><creator>Mehta, Rajendra H</creator><creator>Kaul, Padma</creator><creator>Pieper, Karen S</creator><creator>Hochman, Judith S</creator><creator>Weaver, W. 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Douglas</au><au>Armstrong, Paul W</au><au>Granger, Christopher B</au><au>Patel, Manesh R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>International Variation in and Factors Associated With Hospital Readmission After Myocardial Infarction</atitle><jtitle>JAMA : the journal of the American Medical Association</jtitle><addtitle>JAMA</addtitle><date>2012-01-04</date><risdate>2012</risdate><volume>307</volume><issue>1</issue><spage>66</spage><epage>74</epage><pages>66-74</pages><issn>0098-7484</issn><eissn>1538-3598</eissn><coden>JAMAAP</coden><abstract>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.</abstract><cop>Chicago, IL</cop><pub>American Medical Association</pub><pmid>22215167</pmid><doi>10.1001/jama.2011.1926</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Australia - epidemiology Biological and medical sciences Canada - epidemiology Cardiology. Vascular system Coronary heart disease Europe - epidemiology Female Forecasting General aspects Heart Heart attacks Hospital Mortality Humans Internationality Length of Stay - statistics & numerical data Male Medical sciences Middle Aged Miscellaneous Myocardial Infarction - therapy New Zealand - epidemiology Outcome Assessment (Health Care) Patient admissions Patient Discharge Patient Readmission - statistics & numerical data Public health. Hygiene Public health. Hygiene-occupational medicine Randomized Controlled Trials as Topic Risk Factors United States - epidemiology |
| title | International Variation in and Factors Associated With Hospital Readmission After Myocardial Infarction |
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