Key result
Among young adults hospitalized with AMI, 30.4% were readmitted within 1 year; a 10-predictor risk model incorporating psychosocial factors demonstrated modest discrimination (C statistic=0.67).
Why the study?
Readmission within the first year after acute myocardial infarction is common among adults 55 years or younger, motivating a prediction model that considers a broad range of factors.
Observational (n=2,979)
Yes
A risk prediction model incorporating psychosocial and clinical factors demonstrated modest discrimination for 1-year readmission in young adults following AMI, highlighting the importance of psychosocial characteristics in this population.
Answers are grounded in this paper and cite their sources.
Supports inclusion of psychosocial factors in readmission models for young AMI patients; leaves open clinical utility pending external validation.
Background Readmission over the first year following hospitalization for acute myocardial infarction (AMI) is common among younger adults (≤55 years). Our aim was to develop/validate a risk prediction model that considered a broad range of factors for readmission within 1 year. Methods and Results We used data from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study, which enrolled young adults aged 18 to 55 years hospitalized with AMI across 103 US hospitals (N=2979). The primary outcome was ≥1 all-cause readmissions within 1 year of hospital discharge. Bayesian model averaging was used to select the risk model. The mean age of participants was 47.1 years, 67.4% were women, and 23.2% were Black. Within 1 year of discharge for AMI, 905 (30.4%) of participants were readmitted and were more likely to be female, Black, and nonmarried. The final risk model consisted of 10 predictors: depressive symptoms (odds ratio [OR], 1.03; 95% CI, 1.01-1.05), better physical health (OR, 0.98; 95% CI, 0.97-0.99), in-hospital complication of heart failure (OR, 1.44; 95% CI, 0.99-2.08), chronic obstructive pulmomary disease (OR, 1.29; 95% CI, 0.96-1.74), diabetes mellitus (OR, 1.23; 95% CI, 1.00-1.52), female sex (OR, 1.31; 95% CI, 1.05-1.65), low income (OR, 1.13; 95% CI, 0.89-1.42), prior AMI (OR, 1.47; 95% CI, 1.15-1.87), in-hospital length of stay (OR, 1.13; 95% CI, 1.04-1.23), and being employed (OR, 0.88; 95% CI, 0.69-1.12). The model had excellent calibration and modest discrimination (C statistic=0.67 in development/validation cohorts). Conclusions Women and those with a prior AMI, increased depressive symptoms, longer inpatient length of stay and diabetes may be more likely to be readmitted. Notably, several predictors of readmission were psychosocial characteristics rather than markers of AMI severity. This finding may inform the development of interventions to reduce readmissions in young patients with AMI.
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Dreyer et al. (2021) conducted an observational in Acute myocardial infarction (n=2,979). Risk factors for 1-year readmission was evaluated on ≥1 all-cause readmissions within 1 year of hospital discharge. Among young adults hospitalized with AMI, 30.4% were readmitted within 1 year; a 10-predictor risk model incorporating psychosocial factors demonstrated modest discrimination (C statistic=0.67).
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