Key result
Early post-discharge follow-up is not associated with lower 30-day readmissions after NSTEMI.
Why the study?
Early physician follow-up after heart failure hospitalizations can reduce readmissions, but whether this benefit extends to reducing 30-day readmissions after acute myocardial infarction was unclear.
Observational (n=25,872)
Yes
Answers are grounded in this paper and cite their sources.
Routine early post-discharge follow-up alone may not curb post-NSTEMI readmissions; leaves open which transitional care components actually improve early outcomes.
BACKGROUND: Hospital readmission rates within 30 days after acute myocardial infarction are a national performance metric. Previous data suggest that early physician follow-up after heart failure hospitalizations can reduce readmissions; whether these results can be extended to acute myocardial infarction is unclear. METHODS AND RESULTS: We analyzed data from the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines (CRUSADE) Registry linked with Medicare claims from 2003 to 2006 for 25 872 non-ST-segment-elevation myocardial infarction patients ≥65 years of age discharged home from 228 hospitals with >25 patients and full revascularization capabilities. After adjusting for patient, treatment, and hospital characteristics, we examined the relationship between hospital-level physician follow-up within 7 days of discharge and 30-day all-cause readmission using logistic regression. The median hospital-level percentage of patients receiving early physician follow-up was 23.3% (interquartile range, 17.1%-29.1%). Among 24 165 patients with Medicare fee-for-service eligibility 30 days after discharge, 18.5% of patients were readmitted within 30 days of index hospitalization. Unadjusted and adjusted rates of 30-day readmission did not differ among quartiles of hospital-level early physician follow-up. Similarly, each 5% increase in hospital early follow-up was associated with an insignificant change in risk for readmission (adjusted odds ratio, 0.99; 95% confidence interval, 0.97-1.02; P=0.60). Sensitivity analyses extended these null findings to 30-day cardiovascular readmissions, high-risk subgroups, and early cardiology follow-up. CONCLUSIONS: Although rates of early physician follow-up after acute myocardial infarction varied among US hospitals, hospitals with higher early follow-up rates did not have lower 30-day readmission rates. Targeting strategies other than early physician follow-up may be necessary to reduce readmissions in this population.
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Hess et al. (2013) conducted an observational in Non-ST-segment-elevation myocardial infarction (NSTEMI) (n=25,872). Hospital-level physician follow-up within 7 days of discharge (per 5% increase) vs. Lower hospital-level rates of early physician follow-up was evaluated on 30-day all-cause readmission (OR 0.99, 95% CI 0.97-1.02, p=0.60). Early physician follow-up within 7 days of discharge was not associated with lower 30-day readmission rates after NSTEMI (adjusted OR 0.99 per 5% hospital-level increase; 95% CI 0.97-1.02; P=0.60).
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