scholarly journals Discharge against medical advice after hospitalisation for acute myocardial infarction

Heart ◽  
2018 ◽  
Vol 105 (4) ◽  
pp. 315-321 ◽  
Author(s):  
Chun Shing Kwok ◽  
Mary Norine Walsh ◽  
Annabelle Volgman ◽  
Mirvat Alasnag ◽  
Glen Philip Martin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Risk Groups ◽  
Medical Advice ◽  
Adverse Outcomes ◽  
Unplanned Readmission ◽  
Crude Rate ◽  
Against Medical Advice ◽  
Discharge Against Medical Advice ◽  
Poor Outcomes

BackgroundDischarge against medical advice (AMA) occurs infrequently but is associated with poor outcomes. There are limited descriptions of discharges AMA in national cohorts of patients with acute myocardial infarction (AMI). This study aims to evaluate discharge AMA in AMI and how it affects readmissions.MethodsWe conducted a cohort study of patients with AMI in USA in the Nationwide Readmission Database who were admitted between the years 2010 and 2014. Descriptive statistics were presented for variables according to discharge home or AMA. The primary end point was all-cause 30-day unplanned readmissions and their causes.Results2663 019 patients were admitted with AMI of which 10.3% (n=162 070) of 1569 325 patients had an unplanned readmission within 30 days. The crude rate of discharge AMA remained stable between 2010 and 2014 at 1.5%. Discharge AMA was an independent predictor of unplanned all-cause readmissions (OR 2.27 95% CI 2.14 to 2.40); patients who discharged AMA had >twofold increased crude rate of readmission for AMI (30.4% vs 13.4%) and higher crude rate of admissions for neuropsychiatric reasons (3.2% vs 1.3%). After adjustment, discharge AMA was associated with increased odds of readmissions for AMI (OR 3.65 95% CI 3.31 to 4.03, p<0.001). We estimate that there are 1420 excess cases of AMI among patients who discharged AMA.ConclusionsDischarge AMA occurs in 1.5% of the population with AMI and these patients are at higher risk of early readmissions for re-infarction. Interventions should be developed to reduce discharge AMA in high-risk groups and initiate interventions to avoid adverse outcomes and readmission.

MORTALITY OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION WHO LEAVE THE HOSPITAL AGAINST MEDICAL ADVICE

2019 ◽  
Vol 73 (9) ◽  
pp. 122
Author(s):  
William J. Kostis ◽  
Stavros Zinonos ◽  
Nora Cosgrove ◽  
John Kostis ◽  
Javier Cabrera
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Medical Advice ◽  
Against Medical Advice

scholarly journals Predictors of Discharge Against Medical Advice in a Tertiary Paediatric Hospital

2019 ◽  
Vol 16 (8) ◽  
pp. 1326 ◽  
Author(s):  
Sealy ◽  
Zwi ◽  
McDonald ◽  
Saavedra ◽  
Crawford ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Significant Risk ◽  
Tertiary Hospital ◽  
Medical Advice ◽  
Adverse Outcomes ◽  
Admission Diagnosis ◽  
Against Medical Advice ◽  
Paediatric Hospital ◽  
Hospital Site ◽  
Discharge Against Medical Advice

Background: Patients who discharge against medical advice (DAMA) from hospital carry a significant risk of readmission and have increased rates of morbidity and mortality. We sought to identify the demographic and clinical characteristics of DAMA patients from a tertiary paediatric hospital. Methods: Data were extracted retrospectively from electronic medical records for all inpatient admissions over a 5-year period. Demographic characteristics (age, sex, Aboriginality, socioeconomic status and remoteness of residence) and clinical characteristics (admitting hospital site, level of urgency on admission, diagnosis and previous DAMA) were extracted and logistic regression models were used to identify predictors of DAMA with 95% confidence intervals. Results: There were 246,359 admissions for 124,757 patients, of which 1871 (0.8%) admissions and 1730 patients (1.4%) DAMA. Predictors of DAMA in a given admission were hospital site (OR 4.8, CI 4.2–5.7, p < 0.01), a mental health/behavioural diagnosis (OR 3.3, CI 2.2–4.8, p < 0.01), Aboriginality (OR 1.6, CI 1.3–2.1, p < 0.01), emergency rather than elective admissions (OR 0.7ha, CI 0.6–0.8, p < 0.01), a gastrointestinal diagnosis (OR 1.5, CI 1.1–2.0, p = 0.04) and a history of previous DAMA (OR 2.0, CI 1.2–3.2, p = 0.05). Conclusions: There are clear predictors of DAMA in this tertiary hospital admission cohort and identification of these provides opportunities for intervention at a practice and policy level in order to prevent adverse outcomes.

scholarly journals Continuous aspirin administration in patients of myocardial infraction during their hospital stay - a clinic audit

2016 ◽  
Vol 12 (1) ◽  
Author(s):  
Hammad Ali ◽  
Ahmed Ali
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Stay ◽  
Medical Advice ◽  
Medical Ward ◽  
Recommended Dose ◽  
Against Medical Advice ◽  
Retrospective Audit ◽  
Myocardial Infraction ◽  
Acute Mi

This audit was performed to check whether all patients suffering from myocardial infarction have received aspirin in dose of 160 - 325 mg during their stay in the medical ward in Mayo hospital Lahore. Objectives: The audit was performed to assess the application of ACC/AHA guidelines for management of patients with acute MI regarding administration of aspirin in a dose of 160-325 mg daily during their stay in the hospital. Criteria of audit: A dose of 160-325 mg of aspirin should be continued indefinitely daily after an attack of MI7. Standard of audit: All patients who have been diagnosed to have acute myocardial infarction should receive 160- 325 mg of aspirin daily during hospital stay and continuously thereafter. Material and methods: A retrospective audit was conducted in medical ward in Mayo hospital, Lahore in which notes of patients who were admitted with a diagnosis of acute myocardial infarction from 1st Jan 2005 to 31st August 2005 were studied. Results: We found that patients included in this audit had a mean age of 56 years +/- 13.55 out of which 45 patients 84% were discharged, 2% were discharged on request, 4 % were shifted to CCU, 6% left against medical advice and 2% expired. We found out that out of 45 cases only 24.4 % of cases were given aspirin in the recommended dose of 160- 325 mg daily, 40 % of patients received only 75 mg aspirin daily, while 33.3 % of them got 150mg daily and 2.2 % of patients did not receive aspirin during their stay in the hospital.

The combined impact of Type D personality and depression on cardiovascular events after acute myocardial infarction

2021 ◽  
pp. 1-11
Author(s):  
Yini Wang ◽  
Xueqin Gao ◽  
Zhenjuan Zhao ◽  
Ling Li ◽  
Guojie Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Significant Risk ◽  
Type D Personality ◽  
Adverse Outcomes ◽  
Combined Effect ◽  
Continuous Variables ◽  
Type D

Abstract Background Type D personality and depression are the independent psychological risk factors for adverse outcomes in cardiovascular patients. The aim of this study was to examine the combined effect of Type D personality and depression on clinical outcomes in patients suffering from acute myocardial infarction (AMI). Methods This prospective cohort study included 3568 patients diagnosed with AMI between February 2017 and September 2018. Type D personality and depression were assessed at baseline, while the major adverse cardiac event (MACE) rate (cardiac death, recurrent non-fatal myocardial infarction, revascularization, and stroke) and in-stent restenosis (ISR) rate were analyzed after a 2-year follow-up period. Results A total of 437 patients developed MACEs and 185 had ISR during the follow-up period. The Type D (+) depression (+) and Type D (+) depression (−) groups had a higher risk of MACE [95% confidence interval (CI) 1.74–6.07] (95% CI 1.25–2.96) and ISR (95% CI 3.09–8.28) (95% CI 1.85–6.22). Analysis of Type D and depression as continuous variables indicated that the main effect of Type D, depression and their combined effect were significantly associated with MACE and ISR. Moreover, Type D (+) depression (+) and Type D (+) depression (−) emerged as significant risk factors for MACE and ISR in males, while only Type D (+) depression (+) was associated with MACE and ISR in female patients. Conclusions These findings suggest that patients complicated with depression and Type D personality are at a higher risk of adverse cardiovascular outcomes. Individual assessments of Type D personality and depression, and comprehensive interventions are required.

scholarly journals Why Do Patients Leave against Medical Advice? Reasons, Consequences, Prevention, and Interventions

Healthcare ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 111
Author(s):  
Asseel Albayati ◽  
Steven Douedi ◽  
Abbas Alshami ◽  
Mohammad A. Hossain ◽  
Shuvendu Sen ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Medical Advice ◽  
Preventive Strategies ◽  
Against Medical Advice ◽  
Cause Analysis ◽  
Persistent Problem ◽  
Root Cause ◽  
Discharge Against Medical Advice ◽  
Leaving Against Medical Advice

Background: A patient decides to leave the hospital against medical advice. Is this an erratic eccentric behavior of the patient, or a gap in the quality of care provided by the hospital? With a significant and increasing prevalence of up to 1–2% of all hospital admissions, leaving against medical advice affects both the patient and the healthcare provider. We hereby explore this persistent problem in the healthcare system. We searched Medline and PubMed within the last 10 years, using the keywords “discharge against medical advice,” “DAMA,” “leave against medical advice,” and “AMA.” We retrospectively reviewed 49 articles in our project. Ishikawa fishbone root cause analysis (RCA) was employed to explore reasons for leaving against medical advice (AMA). This report presents the results of the RCA and highlights the consequences of discharge against medical advice (DAMA). In addition, the article explores preventive strategies, as well as interventions to ameliorate leaving AMA.

The Role of Uric Acid in the Acute Myocardial Infarction: A Narrative Review

Angiology ◽  
2021 ◽  
pp. 000331972110125
Author(s):  
Atalay Demiray ◽  
Baris Afsar ◽  
Adrian Covic ◽  
Masanari Kuwabara ◽  
Charles J. Ferro ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Uric Acid ◽  
Adverse Outcomes ◽  
Narrative Review ◽  
Background Information ◽  
Pathophysiological Role ◽  
Artery Disease ◽  
Pathologic Processes

Increased serum uric acid (SUA) levels have been associated with various pathologic processes such as increased oxidative stress, inflammation, and endothelial dysfunction. Thus, it is not surprising that increased SUA is associated with various adverse outcomes including cardiovascular (CV) diseases. Recent epidemiological evidence suggests that increased SUA may be related to acute myocardial infarction (AMI). Accumulating data also showed that elevated UA has pathophysiological role in the development of AMI. However, there are also studies showing that SUA is not related to the risk of AMI. In this narrative review, we summarized the recent literature data regarding SUA and AMI after providing some background information for the association between UA and coronary artery disease. Future studies will show whether decreasing SUA levels is beneficial for outcomes related to AMI and the optimum SUA levels for best outcomes in CV diseases.

Sign in / Sign up

Export Citation Format

Share Document