Department of Cardiology, Concord Repatriation General Hospital, Hospital Road, Concord, NSW 2139, Australia.
Heart. 2012 Dec;98(23):1728-31. doi: 10.1136/heartjnl-2012-302532. Epub 2012 Sep 25.
Readmission following an acute coronary syndrome (ACS) is frequent in our community. Patient specific factors identifying those at risk of readmission are poorly described.
Data were analysed from 5219 patients with an ACS enrolled in the Australian and New Zealand population of the Global Registry of Acute Coronary Events (GRACE) between 1999 and 2007. Patients who were readmitted for cardiovascular disease within 6 months of discharge were identified; regression analysis was used to predict independent patient factors associated with readmission 1 month and 1-6 months after discharge.
1048 patients (20.1%) were readmitted within 6 months, with a significant proportion (n=434, 41.4%) of readmissions occurring within 30 days of discharge. Readmission within 6 months was associated with a higher incidence of unscheduled cardiac catheterisation (HR 25.64, 95% CI 18.41 to 35.71), unscheduled percutaneous coronary intervention (PCI) (HR 15.78, 95% CI 10.56 to 23.59), stroke (HR 1.92, 95% CI 1.08 to 3.43), and death (HR 2.40, 95% CI 1.66 to 3.49). Recurrent ischemia in hospital and a diagnosis of S-T elevation myocardial infarction during the index admission were associated with the strongest risk of early rehospitalisation, while revascularisation by PCI or coronary artery bypass surgery (CABG) was associated with lowest risk of early readmission. A history of heart failure, prior myocardial infarction or angina was associated with a greater likelihood of later rehospitalisation, whereas revascularisation by CABG was associated with the lowest risk of later rehospitalisation.
Several patient and clinical factors identify patients at higher risk of readmission. Identifying these factors and escalating in-hospital and post-discharge care for these higher risk patients may prevent readmission and improve outcome.
在我们的社区中，急性冠状动脉综合征（ACS）后再入院的情况很常见。对于那些有再入院风险的患者，患者特定因素描述得很差。
对 1999 年至 2007 年期间在澳大利亚和新西兰人群中的全球急性冠状动脉事件登记处（GRACE）登记的 5219 例 ACS 患者的数据进行了分析。确定了出院后 6 个月内因心血管疾病再次入院的患者；回归分析用于预测与出院后 1 个月和 1-6 个月时再入院相关的独立患者因素。
在 6 个月内，有 1048 例（20.1%）患者再入院，其中有显著比例（n=434，41.4%）的患者在出院后 30 天内再入院。6 个月内再入院与未计划的心脏导管插入术（HR 25.64，95%CI 18.41 至 35.71）、未计划的经皮冠状动脉介入治疗（PCI）（HR 15.78，95%CI 10.56 至 23.59）、中风（HR 1.92，95%CI 1.08 至 3.43）和死亡（HR 2.40，95%CI 1.66 至 3.49）的发生率较高相关。住院期间再次出现缺血和指数入院时诊断为 ST 段抬高型心肌梗死与早期再住院的风险最强相关，而经 PCI 或冠状动脉旁路移植术（CABG）血运重建与早期再入院的风险最低相关。心力衰竭、既往心肌梗死或心绞痛病史与以后再住院的可能性更大相关，而 CABG 血运重建与以后再住院的风险最低相关。
有几个患者和临床因素可以确定再入院风险较高的患者。确定这些因素，并为这些高风险患者加强住院期间和出院后的护理，可能会预防再入院并改善结局。
