Patients in the United States suffering a ST-segment elevation myocardial infarction (STEMI) following a heart attack were more likely to be readmitted to the hospital within 30 days than patients in other countries, according to a study published in JAMA.
Heart attack with STEMI accounts for 29 percent to 38 percent of all heart attacks, say researchers from Duke University, who conducted the study. While 30-day readmission rates have been proposed as a metric for care of patients with STEMI, international rates and predictors of 30-day readmission after STEMI have not been studied, researchers state.
Researchers believe the analysis shows that readmissions may be preventable because rates are nearly one-third lower in other countries, suggesting that the U.S. healthcare system can be modified to decrease readmission rates.
The study analyzed data from a multi-national clinical trial on 5,745 heart attack patients with STEMI at 296 sites in the United States, Canada, Australia, New Zealand, and 13 European countries from July 2004 to May 2006. Of the patients enrolled in the trial, 97 percent survived to hospital discharge and represented 17 countries; 11 percent were readmitted within 30 days from hospital discharge.
Key findings from the report include the following:
- Patients with multivessel disease had almost twice the odds of readmission compared with those without;
- Patients in the United States had a 68 percent increased odds of readmission vs. those outside the United States;
- Thirty-day readmission rates were higher for the United States than for other countries (14.5 percent vs. 9.9 percent).
- Baseline heart rate per 10/min increase was associated with a 9 percent increased odds of readmission;
- Median length of stay was shortest for U.S. patients (3 days) and longest for patients in Germany (8 days).
Other predictors of readmission included recurrent ischemia, chronic obstructive pulmonary disease(COPD), chronic inflammatory conditions, and a history of hypertension.
Source: JAMA, January 3, 2012
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