A review of socioeconomic factors associated with acute myocardial infarction-related mortality and hospital readmissions

Author(s):  
Mercy Buckman ◽  
Amanda Grant ◽  
Sally Henson ◽  
Julia Ribeiro ◽  
Katie Roth ◽  
...  
Author(s):  
Lila M Martin ◽  
Ryan W Thompson ◽  
Timothy G Ferris ◽  
Jagmeet P Singh ◽  
Elizabeth Laikhter ◽  
...  

Introduction: Medicare’s Hospital Readmissions Reduction Program assesses financial penalties for hospitals based on risk-standardized readmission rates after specific episodes of care, including acute myocardial infarction (AMI). Whether the algorithm accurately identifies patients with AMI who have preventable readmission is unknown. Methods: Using administrative data from Medicare, we conducted physician-adjudicated chart reviews of all patients considered 30 day readmissions after AMI attributed to one hospital from July 2012-June 2015. We extracted information about revascularization during index hospitalization. For patients readmitted to the index hospital or an affiliate, we also extracted reason for readmission. Results: Of 199 admissions, 66 (33.2%) received PCI and 19 (9.6%) underwent CABG on index hospitalization. The remainder of patients did not receive any intervention, i.e. 39 patients (19.6%) were declined due to procedural risk, 15 (7.5%) because of goals of care and 14 (7.0%) refused revascularization. Forty-six patients (23.1%) had troponin elevation in the absence of an MI and did not have an indication for revascularization. The most common diagnoses of the 161 (80.9%) patients readmitted to the index hospital or an affiliate were infections and cardiac and non-cardiac chest discomfort (Table 1). Conclusions: Our results demonstrate that many AMI patients who count towards the Medicare penalty do not receive revascularization during the index hospitalization because of high procedural risk or patient preference. Focusing on these patients may improve readmission metric performance. Furthermore, adding administrative codes for prohibitive procedural risk may improve accuracy of the metric as a measure of quality.


2018 ◽  
Vol 82 (11) ◽  
pp. 2845-2851 ◽  
Author(s):  
Koshiro Kanaoka ◽  
Satoshi Okayama ◽  
Kihei Yoneyama ◽  
Michikazu Nakai ◽  
Kunihiro Nishimura ◽  
...  

2007 ◽  
Vol 7 (1) ◽  
pp. 21-25
Author(s):  
Yoshihisa Hirakawa ◽  
Yuichiro Masuda ◽  
Masafumi Kuzuya ◽  
Akihisa Iguchi ◽  
Takaya Kimata ◽  
...  

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Karl E Minges ◽  
Kelly M Strait ◽  
Sarah Camhi ◽  
Judith H Lichtman ◽  
Rachel P Dreyer ◽  
...  

Introduction: Despite the benefits of participation in regular physical activity (PA) following acute myocardial infarction (AMI), little is known about the habitual patterns of PA for young AMI patients, especially expanding beyond findings for those engaged in cardiac rehabilitation. We assessed patterns and determinants in levels of PA over a period of 12-months following AMI. Methods: A 2:1 (women:men) observational study design enrolled 3,572 AMI patients (2,397 women, 67.1%) aged 18-55 years from 103 US, 24 Spanish, and 3 Australian hospitals (2008-2012). Data were obtained by medical record abstraction and patient interviews at baseline (pre-AMI), 1- and 12-months post-AMI. Patients were assigned to AHA defined levels of PA based on self-reported frequency, duration, and intensity, as follows: Active (≥ 150 min/wk moderate or ≥ 75 min/wk vigorous activity), Insufficient (10-149 min/wk moderate or 10-74 min/wk vigorous activity), or Inactive (< 10 min/wk moderate or vigorous activity). We used a generalized estimating equation model to examine the factors associated with insufficient/inactive PA levels over time. Results: At baseline, 1- and 12-months post-AMI, 36.7%, 37.6%, and 40.0% of patients were considered active. There were 27 PA patterns observed from baseline to 12-months (Table). The most frequent were those with no change in PA over time (14% staying active, 7% insufficient, and 13% inactive). Additionally, 25% of patients had an increase (at least a one category change) in PA, while 19% had a decrease between baseline and 12-months post-AMI. Female sex, non-white race, non-active workplaces, smoking, diabetes, hypertension, and obesity were independently associated with being insufficient/inactive over time (all p<.05). Conclusions: Despite clinical recommendations, young adults recovering from AMI experience a wide range of PA patterns. By identifying factors associated with insufficient/inactive PA during recovery, targeted interventions can be introduced prior to hospital discharge.


Global Heart ◽  
2018 ◽  
Vol 13 (4) ◽  
pp. 412-413
Author(s):  
A. Chandrasekaran ◽  
D. Soni ◽  
K. Singh ◽  
K.S. Sadananda ◽  
P. MR ◽  
...  

2018 ◽  
Vol 1 (7) ◽  
pp. e184831 ◽  
Author(s):  
Zihan Jiang ◽  
Rachel P. Dreyer ◽  
John A. Spertus ◽  
Frederick A. Masoudi ◽  
Jing Li ◽  
...  

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