Abstract 17982: Patterns of 30-Day Readmissions Following Acute Myocardial Infarction in the United States: Analysis of the Nationwide Readmission Database
Background: Readmissions following an acute myocardial infarction (AMI) are common among Medicare beneficiaries (≥65 years), and associated with significant costs to the health care system. However, little is known regarding patterns of AMI readmissions in younger age groups in the US.
Methods: In the 2013 Nationwide Readmission Database (NRD), a nationally representative all-payor database of inpatient hospitalizations, we identified adults (≥18 years) discharged alive after an AMI [ICD-9 codes 410. xx] between Jan 1, 2013 - Nov 30, 2013. We used multivariable hierarchical regression models for survey data to identify predictors of 30-day readmission. We also examined how readmission rates varied across key demographic subgroups based on age, gender and income.
Results: We identified 478,247 index AMI hospitalizations (mean age 66.9 years, 38% women, 29% low income), with 26516 cases in the 18-44 age group (6% of AMI; 28% women), 183,703 in 45-64 age group (38% of AMI; 29% women), and 268,027 in ≥65 age group (56% of AMI; 45% women). Overall 30-day readmission rate was 14.5% - older age, female sex and lower income were associated with higher readmissions (model c-statistic 0.67) and varied across age groups (18-44 years: 9.7%; 45-64 years: 11.2% and ≥65 years: 17.3%). Compared to men, readmission rates were higher in women (13.1% vs 16.8%, risk adjusted OR 1.17 95% CI [1.13, 1.21]), and in all 3 age groups, (18-44 years - OR 1.19 [1.01, 1.42]; 45-64 years - OR 1.25 [1.18, 1.32]; ≥65 years - OR 1.12 [1.08, 1.16]). Likewise, risk of 30-day readmission was higher among patients in the lowest income quartile compared to the highest quartile (15.6% vs 13.7%, OR 1.13 [1.07, 1.19]), driven by significant differences in younger patients (45-64 years - OR 1.24 [1.14, 1.34]). Revascularization (PCI/CABG) during the index hospitalization was associated with fewer 30-day readmissions in all age groups (P<0.001), and adjustment for PCI/CABG attenuated the excess readmissions observed in younger women and low income groups.
Conclusion: Female sex and low income are associated with more frequent readmissions across all age groups, even after adjusting for patient comorbidities. Differences in utilization of revascularization explained some of the excess 30-day readmissions.
Author Disclosures: R. Khera: None. S. Jain: None. A. Pandey: None. N. Kumar: None. S. Girotra: None.
- © 2016 by American Heart Association, Inc.