The Association of Early Physician Follow-up and 30-Day Readmission after Non-ST-Segment Elevation Myocardial Infarction among Older Patients
Background—Hospital readmission rates within 30 days following acute myocardial infarction (AMI) are a national performance metric. Prior data suggest that early physician follow-up after heart failure hospitalizations can reduce readmissions; whether these results can be extended to AMI is unclear.
Methods and Results—We analyzed data from the CRUSADE Registry linked with Medicare claims from 2003-2006 for 25,872 non-ST-segment elevation myocardial infarction (NSTEMI) patients ≥65 years old discharged home from 228 hospitals with >25 patients and full revascularization capabilities. After adjusting for patient, treatment, and hospital characteristics, we examined the relationship between hospital-level physician follow-up within 7 days of discharge and 30-day all-cause readmission using logistic regression. The median hospital-level percentage of patients receiving early physician follow-up was 23.3% (IQR 17.1%-29.1%). Among 24,165 patients with Medicare fee-for-service eligibility 30 days after discharge, 18.5% of patients were readmitted within 30 days of index hospitalization. Unadjusted and adjusted rates of 30-day readmission did not differ among quartiles of hospital-level early physician follow-up. Similarly, each 5% increase in hospital early follow-up was associated with an insignificant change in risk for readmission (adjusted OR 0.99; 95% CI 0.97, 1.02; p=0.60). Sensitivity analyses extended these null findings to 30-day cardiovascular readmissions, high-risk subgroups, and early cardiology follow-up.
Conclusions—While rates of early physician follow-up after AMI varied among U.S. hospitals, hospitals with higher early follow-up rates did not have lower 30-day readmission rates. Targeting strategies other than early physician follow-up may be necessary to reduce readmission rates in this population.
- Received June 18, 2013.
- Accepted July 12, 2013.