Social determinants of health affect unplanned readmissions following acute myocardial infarction

2021 ◽  
Vol 10 (1) ◽  
pp. 39-54
Author(s):  
Marguerite M Hoyler ◽  
Mark D Abramovitz ◽  
Xiaoyue Ma ◽  
Diana Khatib ◽  
Richard Thalappillil ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
New York ◽  
Low Socioeconomic Status ◽  
Safety Net ◽  
Insurance Status ◽  
Readmission Rates ◽  
Low Socioeconomic ◽  
Hospital Safety ◽  
Increases In Risk

Background: Low socioeconomic status predicts inferior clinical outcomes in many patient populations. The effects of patient insurance status and hospital safety-net status on readmission rates following acute myocardial infarction are unclear. Materials & methods: A retrospective review of State Inpatient Databases for New York, California, Florida and Maryland, 2007–2014. Results: A total of 1,055,162 patients were included. Medicaid status was associated with 37.7 and 44.0% increases in risk-adjusted readmission odds at 30 and 90 days (p < 0.0001). Uninsured status was associated with reduced odds of readmission at both time points. High-burden safety-net status was associated with 9.6 and 9.5% increased odds of readmission at 30 and 90 days (p < 0.0003). Conclusion: Insurance status and hospital safety-net burden affect readmission odds following acute myocardial infarction.

Abstract P155: Low Socioeconomic Status Relates to Short-term Mortality Risk After Acute Myocardial Infarction, Especially in Men: Results From a Nationwide Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Louise van Oeffelen ◽  
Charles Agyemang ◽  
Carla Koopman ◽  
Michiel Bots ◽  
Karien Stronks ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Low Socioeconomic Status ◽  
Case Fatality ◽  
Day Case ◽  
Short Term ◽  
Low Socioeconomic ◽  
Nationwide Study ◽  
Short Term Mortality ◽  
Age And Sex

Introduction Previous studies show poorer short-term prognosis after an acute myocardial infarction (AMI) in subjects with a low socioeconomic status (SES). Yet, the magnitude of these relations may differ by age and sex. Data on these issues are however scarce. Methods A nationwide Dutch cohort of first AMI patients between January 1 st 1998 and December 31 st 2007 was identified through linkage of national registers. SES was defined as the standardized disposable income on household level in 1997. For every SES quintile, age- and sex- specific short-term mortality rates were quantified. Logistic regression models were used to estimate differences between SES quintiles in out-of-hospital mortality and 28-day case-fatality. Results We identified 70.368 first AMI patients with income data available, of which 55.860 were men and 14.508 were women. There were strong inverse associations between SES and both short-term mortality outcomes when comparing the lowest with the highest income quintile (out-of-hospital mortality: Odds Ratio (OR) 1.26; 95% Confidence Interval (95% CI) 1.18–1.34), 28-day case-fatality: OR 1.26; 95% CI 1.15–1.37). For men graded relations were found across quintiles of SES, whereas for women only differences between the lowest and the highest quintile were seen. These relations remained consistent across all age categories, except for women below 55 years of age. Conclusion The results from our nationwide study show an increased risk of short-term mortality after a first AMI in subjects with a low SES of all ages, which is most pronounced in men.

Abstract 014: Evaluation of Readmission after Acute Myocardial Infarction for Patients Included in Medicare’s Hospital Readmissions Reduction Program

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Lila M Martin ◽  
Ryan W Thompson ◽  
Timothy G Ferris ◽  
Jagmeet P Singh ◽  
Elizabeth Laikhter ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Readmissions ◽  
Index Hospitalization ◽  
Readmission Rates ◽  
Troponin Elevation ◽  
Reduction Program ◽  
Improve Accuracy ◽  
Episodes Of Care ◽  
Index Hospital

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.

scholarly journals Heterogeneous Impact of Geographic Barriers on Provider Choice Evidence from New York County’s Health Market

2018 ◽  
Vol 33 (3) ◽  
pp. 23-45
Author(s):  
Lee Jae Bok ◽  
Roh Chul-young ◽  
Woolley Jonathan A
Keyword(s):  
New York ◽  
Low Socioeconomic Status ◽  
Health Informatics ◽  
Choice Model ◽  
New York State ◽  
Low Socioeconomic ◽  
Geographic Barriers ◽  
Health Market ◽  
York County ◽  
Using Data

Health services should be accessible regardless of citizens’ gender, age, race, or insurance type, and geographic barriers should not interfere with this access. This article aims to assess the heterogeneous impacts of geographic barriers on inpatients’ hospital choices and to examine whether they vary according inpatients’ socioeconomic or insurance status. Using data on providers and inpatients obtained from the New York State Bureau of Health Informatics Office of Quality and Patient Safety for New York County (New York City’s borough of Manhattan) for 2009, we employed a discrete choice model. Our findings reveal that geographic barriers limit inpatients’ choices of hospitals more when they are of low socioeconomic status.

Predictors of 30-Day Mortality in Patients With Refractory Cardiogenic Shock Following Acute Myocardial Infarction Despite a Patent Infarct Artery

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Jason Katz
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
New York ◽  
Cardiogenic Shock ◽  
Martin Luther ◽  
Refractory Cardiogenic Shock

Abstract 503 Jason N Katz, Duke Univ Medical Ctr & Duke Clinical Res Inst, Durham, NC; Amanda L Stebbins, Duke Clinical Res Inst, Durham, NC; John H Alexander, Duke Univ Medical Ctr & Duke Clinical Res Inst, Durham, NC; Harmony R Reynolds, New York Univ, New York, NY; Karen S Pieper, Duke Clinical Res Inst, Durham, NC; Witold Ruzyllo, Natl Inst of Cardiology, Warsaw, Poland; Karl Werdan, Martin-Luther-Univ Halle-Wittenberg, Halle-Wittenberg, Germany; Alexander Geppert, Wilhelminen hospital Vienna, Vienna, Austria; Vladimir Dzavik, Univ of Toronto, Toronto, ON, Canada; Frans Van de Werf, Univ Hosp of Gasthuisberg, Leuven, Belgium; Judith S Hochman, New York Univ, New York, NY; TRIUMPH Investigators Jason Katz, 2008 Finalist and Presenting Author

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