Abstract 169: Targeting Patients with Multiple Readmissions in the Year after Non-ST-Elevation Myocardial Infarction Could Lower Hospital Readmission Rates
Background: Bundled payment policies have focused on 30-day readmission rates after AMI, yet these are likely to lengthen over time. Identifying patients with multiple readmissions in the year after AMI could help focus transitional care efforts on these high risk patients. Methods: Data from the CRUSADE registry linked to Medicare billing data was used to examine longitudinal outcomes of 32,776 NSTEMI patients ≥ 65 years between 2003 and 2006 with 12-month follow-up. Defining frequent readmissions as ≥3 hospitalizations in 12 months, we compared characteristics of patients frequently readmitted vs. not. The association between frequent readmissions and patient characteristics was examined using multivariable logistic regression. Results: Readmission within 12 months after NSTEMI occurred: once (N=8,830, 26.9%); twice (N=4334, 13.2%); 3 times (N=2,319, 7.1%); ≥4 times (N=2470, 7.5%). Those with multiple (≥3) readmissions (14.6%) were older with recent prior hospitalization and greater prevalence of comorbidities. In multivariable analysis, these factors increased discrimination of patients with frequent readmissions, (c-statistic=0.714). Conclusions: Comorbidities and recent prior hospitalization can predict patients with frequent readmissions. Better understanding of the influence of these clinical factors in this high-risk group presents an opportunity to lower hospital readmission rates.