Abstract 14371: Unplanned 30-Day Readmission Risk Among Patients with Acute Myocardial Infarction: A Report from TRANSLATE-ACS

Abstract

Background: Hospital readmissions after acute MI are a CMS hospital performance measure. Current readmission models have relied on administrative data, included planned readmissions, and/or examined limited patient populations and risk factors.

Methods: We analyzed MI patients treated with PCI and discharged alive in the TRANSLATE-ACS study from April 2010 to March 2012. Our primary outcome was unplanned readmissions within 30 days after discharge. Logistic regression modeling was used to examine factors associated with readmission. We considered baseline demographic and clinical variables, as well as measures of quality of life, depression, and transition of care.

Results: Among 5,708 MI patients, 717 (12.6%) were readmitted within 30 days of discharge, with 504 (8.8%) returning for unplanned readmissions. Compared with patients without unplanned readmissions, patients with unplanned readmissions were less often male, married, employed, or college graduates (Table). Unplanned readmission patients more frequently had medical comorbidities, depression, and lower baseline quality of life than non-readmitted patients. Transition-of-care processes, cardiac rehabilitation participation, and physician follow-up were similar between groups. Post-discharge, there was significantly greater perceived financial hardship with medications among patients with unplanned readmissions than patients without. After multivariable modeling, factors significantly associated with 30-day unplanned readmission included female sex, depression, diabetes, presentation with STEMI, and longer length of stay.

Conclusions: Unplanned readmissions within 30 days after acute MI occur in 1 in 11 patients. Although some clinical characteristics are predictive of unplanned readmission, socio-demographic and functional variables may additionally identify patients at risk.