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. 2021 Feb 8;5(2):320-329.
doi: 10.1016/j.mayocpiqo.2020.12.006. eCollection 2021 Apr.

Use of Post-Acute Care Services and Readmissions After Acute Myocardial Infarction Complicated by Cardiac Arrest and Cardiogenic Shock

Saraschandra Vallabhajosyula  1   2   3 , Stephanie R Payne  4 , Jacob C Jentzer  1   2 , Lindsey R Sangaralingham  4 , Kianoush Kashani  2   5 , Nilay D Shah  6   4   7 , Abhiram Prasad  1 , Shannon M Dunlay  1   6
Affiliations

Use of Post-Acute Care Services and Readmissions After Acute Myocardial Infarction Complicated by Cardiac Arrest and Cardiogenic Shock

Saraschandra Vallabhajosyula et al. Mayo Clin Proc Innov Qual Outcomes. .

Abstract

Objective: To evaluate post-acute care utilization and readmissions after cardiac arrest (CA) and cardiogenic shock (CS) complicating acute myocardial infarction (AMI).

Methods: With use of an administrative claims database, AMI patients from January 1, 2010, to May 31, 2018, were stratified into CA+CS, CA only, CS only, and AMI alone. Outcomes included 90-day post-acute care (inpatient rehabilitation or skilled nursing facility) utilization and 1-year emergency department visits and readmissions.

Results: Of 163,071 AMI patients, CA+CS, CA only, and CS only were noted in 3965 (2.4%), 8221 (5.0%), and 6559 (4.0%), respectively. In-hospital mortality was noted in 10,686 (6.6%) patients: CA+CS, 1935 (48.8%); CA only, 2948 (35.9%); CS only, 1578 (24.1%); and AMI alone, 4225 (2.9%) (P<.001). Among survivors, post-acute care services were used in 67,799 (44.5%), with higher use in the CS+CA cohort (1310 [64.6%]; hazard ratio [HR], 1.19; 95% CI, 1.06 to 1.33; P=.003) and CA cohort (2738 [51.9%]; HR, 1.27; 95% CI, 1.20 to 1.35; P<.001) but not in the CS cohort (3048 [61.2%]; HR, 1.03; 95% CI, 0.97 to 1.11; P=.35) compared with the AMI cohort (60,703 [43.3%]). Compared with the AMI cohort (48,990 [35.0%]), patients with CS only (2,085 [41.9%]; HR, 1.16; 95% CI, 1.10 to 1.22; P<.001) but not those with CA+CS (724 [35.7%]; HR, 1.07; 95% CI, 0.98 to 1.17; P=.14) had higher rates of readmissions (P=.03). Readmissions were lower in those with CA (1,590 [30.2%]; HR, 0.94; 95% CI, 0.89 to 0.99). Repeated AMI, coronary artery disease, and heart failure were the most common readmission reasons. There were no differences for emergency department visits.

Conclusion: CA is associated with increased post-acute care use, whereas CS is associated with increased readmission risk in AMI survivors.

Keywords: AMI, acute myocardial infarction; CA, cardiac arrest; CS, cardiogenic shock; ED, emergency department; HR, hazard ratio; ICD-10-CM, International Classification of Diseases, Tenth Revision, Clinical Modification; ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification; MCS, mechanical circulatory support; PCI, percutaneous coronary intervention; SNF, skilled nursing facility.

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Figures

Figure 1
Figure 1
Top 5 reasons for emergency department visits and hospital readmissions. A, Emergency department visits. B, Hospital readmissions.
Figure 2
Figure 2
Kaplan-Meier time-to-event curves for emergency department visits in acute myocardial infarction (AMI) survivors with and without cardiac arrest (CA) and cardiogenic shock (CS).
Figure 3
Figure 3
Kaplan-Meier time-to-event curves for hospital readmissions in acute myocardial infarction (AMI) survivors with and without cardiac arrest (CA) and cardiogenic shock (CS).
See this image and copyright information in PMC

References

    1. Vallabhajosyula S., Dunlay S.M., Barsness G.W., Rihal C.S., Holmes D.R., Jr., Prasad A. Hospital-level disparities in the outcomes of acute myocardial infarction with cardiogenic shock. Am J Cardiol. 2019;124(4):491–498. - PubMed
    1. Vallabhajosyula S., Dunlay S.M., Prasad A., et al. Acute noncardiac organ failure in acute myocardial infarction with cardiogenic shock. J Am Coll Cardiol. 2019;73(14):1781–1791. - PubMed
    1. Vallabhajosyula S., Prasad A., Bell M.R., et al. Extracorporeal membrane oxygenation use in acute myocardial infarction in the United States, 2000 to 2014. Circ Heart Fail. 2019;12(12):e005929. - PMC - PubMed
    1. Vallabhajosyula S., Vallabhajosyula S., Bell M.R., et al. Early vs. delayed in-hospital cardiac arrest complicating ST-elevation myocardial infarction receiving primary percutaneous coronary intervention. Resuscitation. 2020;148:242–250. - PubMed
    1. Jentzer J.C., Clements C.M., Murphy J.G., Scott Wright R. Recent developments in the management of patients resuscitated from cardiac arrest. J Crit Care. 2017;39:97–107. - PubMed

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