Abstract 14309: Relationship of Early Physician Follow-Up and 30-Day Readmission after Non-ST-Segment Elevation Myocardial Infarction Among Older Patients
Background: Hospital readmissions within 30 days after acute myocardial infarction (AMI) are a Medicare hospital performance measure. Prior data suggests that early physician follow-up after heart failure hospitalizations may reduce readmissions. Whether this strategy is effective for AMI patients is unknown.
Methods: We analyzed data from the CRUSADE registry linked with Medicare claims from 2003-2006 for 25,872 NSTEMI patients ≥65 years old discharged home from 228 hospitals with >25 patients and full revascularization capabilities. We examined the relationship between hospital-level physician follow-up within 7 days of discharge and all-cause readmission within 30 days after discharge.
Results: The median hospital-level percentage of patients receiving early physician follow-up was 23.3% (IQR 17.1%-29.1%). Compared with quartiles 1 and 2, patients in quartiles 3 and 4 of hospital-level early follow-up had a greater burden of comorbidities, were less often transferred from another hospital, underwent PCI/CABG less frequently, and had longer length of stay than patients in the lowest quartile. Hospital characteristics across quartiles were similar. Among 24,165 patients with Medicare fee-for-service eligibility 30 days after discharge, 18.5% of patients were readmitted within 30 days after discharge from index hospitalization. Rates of 30-day readmission were similar among quartiles of hospital-level early physician follow-up (Table). After multivariable modeling, there was no association between early physician follow-up and readmission among pairwise comparisons of quartiles 2-4 versus 1 or across all quartiles (adjusted OR per 5% follow-up increase 0.99; 95% CI 0.96, 1.02; p=0.61).
Conclusions: Approximately 20% of older NSTEMI patients in U.S. hospitals are readmitted within 30 days. While rates of early physician follow-up varied among institutions, we did not demonstrate an association between this factor and readmission risk.
- © 2012 by American Heart Association, Inc.