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Comparative Study
. 2013 Sep 10;128(11):1206-13.
doi: 10.1161/CIRCULATIONAHA.113.004569. Epub 2013 Aug 14.

Association of early physician follow-up and 30-day readmission after non-ST-segment-elevation myocardial infarction among older patients

Connie N Hess  1 , Bimal R Shah, S Andrew Peng, Laine Thomas, Matthew T Roe, Eric D Peterson
Affiliations
Comparative Study

Association of early physician follow-up and 30-day readmission after non-ST-segment-elevation myocardial infarction among older patients

Connie N Hess et al. Circulation. .

Abstract

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.

Keywords: coronary disease; myocardial infarction.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr. Shah reports consulting for Castlight. Health, LLC and Cardinal Health. Dr. Roe reports research funding from Eli Lilly & Company, KAI Pharmaceuticals, and Sanofi-Aventis (all significant); educational activities or lectures for AstraZeneca and Janssen Pharmaceuticals (both modest); consulting for Bristol Myers Squibb, Eli Lilly & Company, Glaxo Smith Kline, and Regeneron (all modest), Merck & Co., Janssen Pharmaceuticals, and Daiichi-Sankyo (all significant). Dr. Peterson reports research funding from Eli Lilly & Company, Ortho-McNeil-Janssen Pharmaceuticals, Inc., Society of Thoracic Surgeons, American Heart Association, American College of Cardiology (all significant); consulting for AstraZeneca, Boehringer Ingelheim, Genentech, Johnson & Johnson, Ortho-McNeil-Janssen Pharmaceuticals, Inc., Pfizer, Sanofi-Aventis, and WebMD (all modest). The remaining authors have no disclosures.

Figures

Figure 1
Figure 1
Flow Diagram of Patient Selection. This figure displays inclusions and exclusions and the final study cohort. CABG indicates coronary artery bypass graft; NSTEMI, non-ST-segment elevation myocardial infarction; PCI, percutaneous coronary intervention; STEMI, ST-segment-elevation myocardial infarction.
Figure 2
Figure 2
Variation in Hospital-level Early Physician Follow-up. Shown here is the distribution of hospital-level early physician follow-up. IQR indicates interquartile range.
Figure 3
Figure 3
Adjusted 30-day All-cause Readmission by Hospital-level Early Physician Follow-up. Adjusted odds ratios and 95% confidence intervals are shown for the 2nd through 4th quartiles of hospital-level early physician follow-up using the 1st quartile as the reference group. Model 1 = adjustment for patient demographic and clinical characteristics; Model 2 = covariates in model 1 + hospital features; Model 3 = covariates in model 2 + treatment features. P-values for all odds ratios were >0.05. CI indicates confidence intervals
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