Psychological Stress and 30-Day All-Cause Hospital Readmission in Acute Coronary Syndrome Patients: An Observational Cohort Study

Background: Ageing populations and increasing survival following acute coronary syndrome has resulted in large numbers of people living with cardiovascular disease and at high risk of hospitalizations. Rising hospital admissions have a significant financial cost to the healthcare system. Aim: The purpose of this study was to determine whether cardiac rehabilitation is protective against long-term hospital readmission (frequency and length) following acute coronary syndrome. Methods: Data from 416 Australian patients with acute coronary syndrome enrolled in the Anxiety Depression and heart rate Variability in cardiac patients: Evaluating the impact of Negative emotions on functioning after Twenty four months (ADVENT) prospective cohort study between January 2013–June 2014 was analyzed secondarily. Participants self-reported cardiac rehabilitation attendance over the 12 months post-discharge. All-cause readmission data were extracted from hospital records 24 months post-index event. The association between cardiac rehabilitation and all-cause readmission, frequency of readmissions, and length of stay was assessed using three methods (a) regression analysis, (b) propensity score matching, and (c) inverse probability treatment weighting. Results: Overall, 416 patients consented (53% of eligible patients), of which 414 (99.5%) survived the first 30 days post-discharge and were included in the analysis. Medical records were located for 409 participants after 24 months (98% follow-up rate). In total, 267 (65%) reported attending cardiac rehabilitation; there were 392 readmissions by 239 patients. Cardiac rehabilitation attendance was not associated with all-cause hospital readmission; however, it was associated with lower frequency of hospital admissions (odds ratio 0.53, 95% confidence interval: 0.31–0.91 p-value:0.022) and length of stay (coefficient –1.21 days, 95% confidence interval: –2.46–0.26; marginally significant p-value: 0.055) in adjusted models. Conclusion: This study substantiates the long-term benefits of cardiac rehabilitation on readmissions, including length of stay, which would result in lower costs to the healthcare system.

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Altered serum calcium homeostasis independently predicts mortality in patients with acute coronary syndrome: a retrospective observational cohort study

BMJ Open ◽

10.1136/bmjopen-2021-049957 ◽

2021 ◽

Vol 11 (11) ◽

pp. e049957

Author(s):

Wen Su ◽

Jie-Gao Zhu ◽

Xue-Qiao Zhao ◽

Hui Chen ◽

Wei-Ping Li ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Serum Calcium ◽

Observational Cohort Study ◽

Coronary Syndrome ◽

All Cause Mortality ◽

Observational Cohort ◽

Restricted Cubic Splines ◽

Altered Serum ◽

Retrospective Observational Cohort Study

ObjectivesSerum calcium levels (sCa) were reported to be associated with risk of cardiovascular diseases. The aim of this study was to analyse the association between sCa and long-term mortality in patients with acute coronary syndrome (ACS).DesignA retrospective observational cohort study.SettingSingle-centre study with participants recruited from the local area.ParticipantsA total of consecutive 13 772 patients with ACS were included in this analysis. Patients were divided based on their sCa profile (≤2.1 mmol/L, 2.1–2.2 mmol/L, 2.2–2.3 mmol/L, 2.3–2.4 mmol/L, 2.4–2.5 mmol/L,>2.5 mmol/L) and followed up for a median of 2.96 years (IQR 1.01–4.07).Primary outcomeLong-term all-cause mortality.ResultsDuring a median follow-up period of 2.96 years, patients with sCa ≤2.1 mmol/L had the highest cumulative incidences of all-cause mortality (16.7%), whereas those with sCa 2.4–2.5 mmol/L had the lowest cumulative incidences of all-cause mortality (3.5%). After adjusting for potentially confounding variables, the Cox analysis revealed that compared with the reference group (sCa 2.4–2.5 mmol/L), all the other groups had higher mortality except for the sCa 2.3–2.4 mmol/L group (HR, 1.32, 95% CI 0.93 to 1.87). Restricted cubic splines showed that the relationship between sCa and all-cause mortality seemed to be U shaped. The optimal sCa cut-off point, 2.35 mmol/L, was determined based on the shape of restricted cubic splines.ConclusionsAltered serum calcium homeostasis at admission independently predicts all-cause mortality in patients with ACS. In addition, a U-shaped relationship between sCa and all-cause mortality exists, and maintaining sCa at approximately 2.35 mmol/L may minimise the risk of mortality.

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Association between transitional care factors and hospital readmission after transcatheter aortic valve replacement: a retrospective observational cohort study

BMC Cardiovascular Disorders ◽

10.1186/s12872-019-1003-9 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Andrew Czarnecki ◽

Peter C. Austin ◽

Stephen E. Fremes ◽

Jack V. Tu ◽

Harindra C. Wijeysundera ◽

...

Keyword(s):

Cohort Study ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Hospital Readmission ◽

Transcatheter Aortic Valve Replacement ◽

Transitional Care ◽

Observational Cohort Study ◽

Transcatheter Aortic Valve ◽

Observational Cohort ◽

Retrospective Observational Cohort Study

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Prospective observational cohort study of early recurrent TIA

Neurology ◽

10.1212/wnl.0000000000010317 ◽

2020 ◽

Vol 95 (12) ◽

pp. e1733-e1744

Author(s):

Matteo Foschi ◽

Lucia Pavolucci ◽

Francesca Rondelli ◽

Luca Spinardi ◽

Elisabetta Favaretto ◽

...

Keyword(s):

Cohort Study ◽

Observational Cohort Study ◽

Large Artery ◽

Prospective Observational Cohort Study ◽

Stroke Incidence ◽

Long Term Outcome ◽

Coronary Syndrome ◽

Observational Cohort

ObjectivesTo evaluate the frequency, clinical and etiologic features, and short- and long-term outcomes of early recurrent TIA.MethodsThis prospective observational cohort study enrolled all consecutive patients with TIA referred to our emergency department and diagnosed by a vascular neurologist. Expedited assessment and best secondary prevention were performed within 24 hours. Primary endpoints were stroke and a composite outcome including stroke, acute coronary syndrome, and vascular death at 3, 12, and, for a subset of patients, 60 months; secondary outcomes were TIA relapse, cerebral hemorrhage, new-onset atrial fibrillation, and death resulting from other causes. Concordance between index TIA and subsequent stroke etiologies was also evaluated.ResultsA total of 1,035 patients (822 with a single TIA, 213 with recurrent TIA = 21%) were enrolled from August 2010 to December 2017. Capsular warning syndrome and large artery atherosclerosis showed the strongest relationship with early recurrent TIA. The risk of stroke was significantly higher in the early recurrent TIA subgroup at each follow-up, and most stroke episodes occurred within 48 hours of index TIA. TIAs with lesion, dysarthria, and leukoaraiosis were the 3- and 12-month independent predictors of stroke incidence after early recurrent TIA subgroup. Index TIA and subsequent stroke etiologies showed substantial concordance. An ABCD3 score >6 predicted a higher risk of stroke recurrence over the entire follow-up.ConclusionsOur study evaluated long-term outcome after early recurrent TIA. Our observations support the importance of promptly detecting and treating patients with early recurrent TIAs to reduce the high early and long-term risk of poor clinical outcomes.

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Associations between post-discharge medical consultations and 30-day unplanned hospital readmission: A prospective observational cohort study

European Journal of Internal Medicine ◽

10.1016/j.ejim.2022.01.013 ◽

2022 ◽

Author(s):

Gregor John ◽

Loïc Payrard ◽

Jacques Donzé

Keyword(s):

Cohort Study ◽

Hospital Readmission ◽

Observational Cohort Study ◽

Prospective Observational Cohort Study ◽

Post Discharge ◽

Medical Consultations ◽

Observational Cohort

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Trends of prescribing adherence of antiplatelet agents in Hong Kong patients with acute coronary syndrome: a 10-year retrospective observational cohort study

BMJ Open ◽

10.1136/bmjopen-2020-042229 ◽

2020 ◽

Vol 10 (12) ◽

pp. e042229

Author(s):

Amy SM Lam ◽

Bryan PY Yan ◽

Vivian WY Lee

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Observational Cohort Study ◽

Secondary Outcome ◽

Index Hospitalisation ◽

Coronary Syndrome ◽

Concurrent Use ◽

Observational Cohort ◽

St Elevation ◽

Retrospective Observational Cohort Study

ObjectivesThe objective of this study is to examine the temporal trend of antiplatelet prescribing pattern during index hospitalisation discharge in Hong Kong (HK) acute coronary syndrome (ACS) population.DesignThe study is a retrospective observational cohort study.SettingThe study retrieved data from electronic health record from Hospital Authority (HA), HK.ParticipantsThe study included patients aged 18 years old or above, who were admitted to seven institutions under HA with diagnosis of ACS during 2008–2017.Primary and secondary outcome measuresThe primary outcome was the frequency of antiplatelet therapy prescription at the point of index hospitalisation discharge each year during 2008–2017. Association between demographics, baseline comorbidities, procedures and antiplatelet prescription were examined as secondary outcome using multivariate logistic regression model, with commonly used antiplatelet groups selected for comparison.ResultsAmong the included 14 716 patients, 5888 (40.0%) discharged with aspirin alone, 6888 (46.8%) discharged with dual antiplatelet therapy (DAPT) with clopidogrel, and 973 (6.6%) discharged with DAPT with prasugrel/ticagrelor. Prescribing rate of aspirin alone decreased substantially from 56.8% in 2008 to 27.5% in 2017. Utilisation of DAPT with clopidogrel increased from 33.7% in 2008 to 52.7% in 2017. Use of DAPT with prasugrel/ticagrelor increased from 0.3% in 2010 to 15.3% in 2017. Compared with those prescribed with DAPT with clopidogrel, male patients (adjusted OR (aOR) 1.34, 95% CI 1.09 to 1.65), patients with non-ST-elevation myocardial infarction (aOR 2.50, 1.98 to 3.16) or ST-elevation myocardial infarction (aOR 3.26, 2.59 to 4.09), use of glycoprotein IIb/IIIa (aOR 3.03, 2.48 to 3.68) or undergoing percutaneous coronary intervention (aOR 3.85, 3.24 to 4.58) or coronary artery bypass graft (aOR 6.52, 4.63 to 9.18) during index hospitalisation, concurrent use of histamine-2 receptor antagonists (aOR 1.35, 1.10 to 1.65) or proton pump inhibitors (aOR 3.57, 2.93 to 4.36) during index hospitalisation discharge were more likely to be prescribed with DAPT with prasugrel/ticagrelor. Patients with older age (aOR 0.97, 0.96 to 0.97), diabetes (aOR 0.68, 0.52 to 0.88), chronic kidney disease (aOR 0.43, 0.22 to 0.85) or concurrent use of oral anticoagulant (aOR 0.16, 0.07 to 0.42) were more likely to received DAPT with clopidogrel.ConclusionsUse of DAPT with prasugrel/ticagrelor was suboptimal yet improving during 2008–2017 in HK patients with ACS. Considering DAPT, predictors for clopidogrel prescription, compared with prasugrel/ticagrelor, were consistent with identified risk factors of bleeding.

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