scholarly journals Influence of socioeconomic factors on hospital readmissions for heart failure and acute myocardial infarction in patients 65 years and older: evidence from a systematic review

2015 ◽  
pp. 237 ◽  
Author(s):  
Gianfranco Damiani ◽  
Eleonora Salvatori ◽  
Giulia Silvestrini ◽  
Ivana Ivanova ◽  
Luka Bojovic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Systematic Review ◽  
Acute Myocardial Infarction ◽  
Socioeconomic Factors ◽  
Hospital Readmissions

Abstract 148: The Timing of 30-Day Readmissions after Hospitalization for Heart Failure and Acute Myocardial Infarction

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Kumar Dharmarajan ◽  
Fu-Chi Hsieh ◽  
Zhenqiu Lin ◽  
Joseph S Ross ◽  
Nancy Kim ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Coronary Revascularization ◽  
Hospital Readmissions ◽  
Cumulative Number ◽  
Readmission Rates ◽  
Time Period ◽  
Equal Rate ◽  
Readmission Risk

Background: Readmissions are frequent and costly outcomes in patients hospitalized for heart failure (HF) and acute myocardial infarction (AMI). Knowledge of the exact timing of 30-day readmissions after hospitalization for HF and AMI can help identify time periods during which patients are at the highest readmission risk and guide the development of interventions designed to prevent early readmissions. Methods: Using Medicare Standard Analytic and Denominator files, we identified all HF and AMI hospitalizations in 2007-2009. We excluded hospitalizations for patients aged<65, transferred out, discharged against medical advice, or with an inpatient death. For both HF and AMI cohorts, we identified all readmissions to short-stay acute care hospitals due to any cause occurring within 30 days of hospital discharge except for planned coronary revascularization. Our primary outcome was the number of observed readmissions occurring during each day (0-30) after discharge. We also calculated the cumulative number of observed readmissions occurring during the 1 st 3 days, 1 st week, and 1 st 15 days after discharge. We used a one-tailed two-proportion z test to evaluate if the proportion of readmissions during the 1 st 3 days, 1 st week, and 1 st 15 days was higher than what would be expected had readmissions occurred at an equal rate during the 30 days (alpha=0.05). Results: We identified 329,308 readmissions within 30 days after 1,330,157 hospitalizations for HF (4,633 hospitals) and 108,992 readmissions within 30 days after 548,834 hospitalizations for AMI (3,895 hospitals). Readmission frequency by day is described for both HF and AMI in the accompanying figure. Following hospitalization for HF, 13.4% of 30-day readmissions occur during the 1 st 3 days after discharge, 31.7% occur during the 1 st week, and 61.0% occur during the 1 st 15 days. Following hospitalization for AMI, 19.1% of 30-day readmissions occur during the 1 st 3 days after discharge, 40.1% occur during the 1 st week, and 67.6% occur during the 1 st 15 days. For both HF and AMI cohorts, readmissions after 3, 7, and 15 days were higher than what would be predicted had readmission rates remained constant (p<0.0001 for all). Conclusion: For patients hospitalized with HF and AMI, a disproportionately high percentage of 30-day readmissions occur soon after discharge. Interventions designed to reduce hospital readmissions may therefore generate substantive benefits when applied to the time period shortly after hospitalization.

scholarly journals Effects and Safety of Sacubitril/Valsartan for Patients with Myocardial Infarction: A Systematic Review and Meta-Analysis

2022 ◽  
Vol 2022 ◽  
pp. 1-8
Author(s):  
Lang Liu ◽  
Xiaofang Ding ◽  
Yaxiang Han ◽  
Jianfeng Lv
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Systematic Review ◽  
Acute Myocardial Infarction ◽  
Meta Analysis ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Patients With Heart Failure ◽  
Valsartan Group ◽  
The Difference

Patients who develop heart failure (HF) after an acute myocardial infarction (AMI) are at higher risk of adverse fatal and nonfatal outcomes. Studies have shown sacubitril/valsartan can further reduce the risk of cardiovascular death or hospitalization for heart failure by 20% compared with enalapril. At the same time, its tolerance and safety are better. However, the current evidence regarding the efficacy of sacubitril/valsartan in patients with heart failure after acute myocardial infarction is controversial. To assess the effect of sacubitril/valsartan on heart failure after acute myocardial infarction, we conducted a systematic review of the literature and a meta-analysis of existing randomized clinical trials. Meta-analysis of randomized controlled trails is used where data are collected from PubMed, the Cochrane library, Embase, and Web of Science. Data about sacubitril/valsartan were available from 5 studies. Forest plots showed that the sacubitril/valsartan group had a 299% higher value of sacubitril/valsartan to the control group (MD = 2.99%, 95% CI: 2.01, 3.96, I2 = 78%, P < 0.00001 , Figure 2), and the difference was statistically significant. Forest plots showed that the sacubitril/valsartan group had a 531% lower value of LVEF to the control group (MD = −5.31%, 95% CI: −7.36, −3.26, I2 = 91%, P < 0.00001 , Figure 2), and the difference was statistically significant. Forest plots showed that the sacubitril/valsartan group had a 133% lower value of NT-proBNP to the control group (MD = −1.33%, 95% CI: −1.54, −1.12, I2 = 96%, P < 0.00001 , Figure 3). Forest plots showed that the sacubitril/valsartan group had a 49% lower risk of heart failure to the control group (MD = 0.49, 95% CI: 0.27, 0.89, I2 = 0%, P = 0.02 , Figure 3). The patients in experimental showed an obviously lower OR of MACE (OR = 0.47, 95% CI: 0.27, 0.82, P = 0.007 , Figure 3). The data were statistically significant. We have observed that for patients with heart failure after acute myocardial infarction, early administration of sacubitril/valsartan can significantly reduce the incidence of heart rate, left ventricular ejection fraction, NT-proBNP, and MACE. Our meta-analysis suggests that taking sacubitril/valsartan is relatively safe and effective, especially if started early after acute myocardial infarction.

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