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Observational Study
. 2018 Mar 23;7(6):e008235.
doi: 10.1161/JAHA.117.008235.

Prevalence, Causes, and Predictors of 30-Day Readmissions Following Hospitalization With Acute Myocardial Infarction Complicated By Cardiogenic Shock: Findings From the 2013-2014 National Readmissions Database

Ahmed N Mahmoud  1 , Islam Y Elgendy  2 , Mohammad K Mojadidi  2 , Siddharth A Wayangankar  2 , Anthony A Bavry  2 , R David Anderson  2 , Hani Jneid  3 , Carl J Pepine  2
Affiliations
Observational Study

Prevalence, Causes, and Predictors of 30-Day Readmissions Following Hospitalization With Acute Myocardial Infarction Complicated By Cardiogenic Shock: Findings From the 2013-2014 National Readmissions Database

Ahmed N Mahmoud et al. J Am Heart Assoc. .

Abstract

Background: Prior studies have shown that survivors of acute myocardial infarction (AMI) complicated by cardiogenic shock are likely to have increased risk of readmissions in the early post-discharge period. However, the contemporary prevalence, reasons, and predictors of 30-day readmissions are not well known.

Methods and results: Hospitalizations for a primary diagnosis of AMI complicated by cardiogenic shock, and discharged alive, were identified in the 2013 and 2014 Nationwide Readmissions Databases. Prevalence and reasons for 30-day unplanned readmissions were investigated. A hierarchical logistic regression model was used to identify independent predictors of 30-day readmissions. Among 1 116 933 patient hospitalizations with AMI, 39 807 (3.6%) had cardiogenic shock and were discharged alive. Their 30-day readmission rate was 18.6%, with a median time for readmission 10 days post discharge. Predictors of readmission included: non-ST-segment elevation myocardial infarction, female sex, low-income status, nonprivate insurance, chronic renal failure, long-term ventricular assist device or intra-aortic balloon placement, and tachyarrhythmia. The majority of readmissions were attributable to cardiac-related causes (52%); heart failure being the most frequent cardiac cause (39% of all cardiac causes). Noncardiac-related readmissions included infections (14.9%), bleeding (5.3%), and respiratory causes (4.9%). The median cost per readmission was $9473 US dollars ($5037-20 199).

Conclusions: Among survivors of AMI complicated by cardiogenic shock who were discharged from hospital, almost 1 in 5 are readmitted at 30 days, mainly because of cardiac reasons such as heart failure and new AMI. The risk of readmission was associated with certain baseline patient/hospital characteristics.

Keywords: cardiogenic shock; heart failure; myocardial infarction; readmission.

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Figures

Figure 1
Figure 1
Study flow chart diagram. AMI indicates acute myocardial infarction.
Figure 2
Figure 2
Frequencies of readmission according to the number of days after discharge in the acute myocardial infarction with cardiogenic shock hospitalization cohort.
Figure 3
Figure 3
Overall causes of 30‐day readmission. GI indicates gastrointestinal.
Figure 4
Figure 4
Cardiac causes of 30‐day readmission. CAD indicates coronary artery disease; CHF, congestive heart failure; DVT/PE, deep venous thrombosis/pulmonary embolism; NSTEMI, non–ST‐segment elevation myocardial infarction; STEMI, ST‐segment elevation myocardial infarction (Percentage is out of all cardiac 30‐day readmissions).
Figure 5
Figure 5
Infectious causes of 30‐day readmission. GI indicates gastrointestinal; UTI, urinary tract infection (Percentage is out of all infectious causes of 30‐day readmissions).
Figure 6
Figure 6
Bleeding causes of 30‐day readmission. GIB indicates gastrointestinal bleeding; ICH, intracranial hemorrhage (Percentage is out of all bleeding causes of 30‐day readmissions).
See this image and copyright information in PMC

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