Key result
Interhospital transfer for acute MI was associated with lower 30-day outpatient follow-up and higher 30-day readmission than direct arrival.
Why the study?
Does interhospital transfer for acute MI care affect outpatient follow-up and 30-day readmission or mortality in older adults compared to direct arrival?
Cohort (n=39,136)
Yes
Does interhospital transfer for acute MI care affect outpatient follow-up and 30-day readmission or mortality in older adults compared to direct arrival?
Older patients transferred between hospitals for acute MI care experience worse care transitions, with lower rates of 30-day outpatient follow-up and higher 30-day readmission rates compared to those arriving directly.
Answers are grounded in this paper and cite their sources.
May warrant closer transition monitoring for transferred MI patients; leaves open whether transfer processes drive worse outcomes.
BACKGROUND: Many patients in the United States require transfer from one hospital to another for acute myocardial infarction (MI) care. How well these transferred-in patients are transitioned back to their local community is unknown. METHODS AND RESULTS: We used linked Medicare claims data to examine postdischarge outcomes of 39 136 patients with acute MI aged ≥65 years discharged alive from 451 US hospitals in Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines. Multivariable Cox modeling was used to compare the likelihood of outpatient clinic follow-up and risks of all-cause mortality and all-cause or cardiovascular readmission at 30 days post MI between transferred-in and direct-arrival patients. From 2007 to 2010, 14 060 of 39 136 patients (36%) required interhospital transfer for acute MI care, traveling a median of 43 miles (interquartile range, 27-68 miles; 77.6 km [interquartile range, 48.2-122.6 km]). Compared with those arriving directly, transferred-in patients with MI were slightly younger (median age, 73 versus 74; P<0.01) but less likely to have previous MI, heart failure, and previous revascularization than direct-arrival patients. Relative to direct-arrival patients, those transferred-in had a lower likelihood of outpatient follow-up within 30 days post discharge (risk-adjusted incidence, 69.9% versus 78.2%; hazard ratio [HR], 0.90; 95% confidence interval, 0.87-0.92) and higher adjusted 30-day all-cause and cardiovascular readmission risks (14.5% versus 14.0%; HRall-cause, 1.08; 95% confidence interval, 1.01-1.15 and 9.5% versus 9.1%; HRcardiovascular, 1.13; 95% confidence interval, 1.04-1.22). In contrast, risk-adjusted 30-day mortality was similar between transferred-in and direct arrivals (1.6% versus 1.6%; HR, 1.05; 95% confidence interval, 0.86-1.27). CONCLUSIONS: Transferred-in patients with acute MI are less likely to have outpatient clinic follow-up within 30 days and more likely to be readmitted within the first 30 days post discharge compared with direct-arrival patients. These results indicate room for improvement in the safe and seamless transition of care for transferred patients with MI traveling back to their home environments.
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Vora et al. (2016) conducted a cohort in Acute myocardial infarction (n=39,136). Interhospital transfer vs. Direct arrival was evaluated on Outpatient follow-up within 30 days post discharge (HR 0.90, 95% CI 0.87-0.92). Interhospital transfer for acute MI was associated with lower 30-day outpatient follow-up and higher 30-day readmission than direct arrival.
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