Unplanned Inpatient and Observation Rehospitalizations After Acute Myocardial Infarction: Insights From the TRANSLATE-ACS Study
Background—Previous studies examining early readmission after acute myocardial infarction (MI) have focused exclusively on inpatient readmissions. Yet from a patient's perspective, any unplanned inpatient or observation rehospitalization after acute MI represents a significant event; these unplanned rehospitalizations have not been well-characterized.
Methods and Results—We examined all acute MI patients treated with percutaneous coronary intervention discharged alive from 233 hospitals in the TRANSLATE-ACS study from 2010-2012. Our primary outcome was unplanned rehospitalizations (inpatient or observation status) within 30 days post-discharge. We identified factors associated with unplanned rehospitalizations using multivariable logistic regression. Among 12,312 patients, 1,326 (10.8%) had 1,483 unplanned rehospitalizations within 30 days of the index event; 1,028 (69.3%) were inpatient readmissions, and 455 (30.7%) were observation stays. The majority of unplanned rehospitalizations (72%) were for cardiovascular reasons. Variation in hospital rates of 30-day unplanned rehospitalization ranged from 5.4% to 20.0%, with a median of 10.7%. After multivariable modeling, the factors most strongly associated with unplanned rehospitalization were baseline quality of life and depression, followed by index hospital length of stay.
Conclusions—Early unplanned rehospitalizations are common after acute MI, and close to one-third were classified as an observation stay. Pre- and post-discharge assessments of overall, not just cardiovascular, health and strategies to optimize patient functional status may help to reduce unplanned rehospitalizations.
Clinical Trial Registration Information—https://clinicaltrials.gov. Identifier: NCT01088503.
- Received April 14, 2015.
- Revision received November 13, 2015.
- Accepted November 20, 2015.