Chen Han-Yang, Tisminetzky Mayra, Lapane Kate L, Yarzebski Jorge, Person Sharina D, Kiefe Catarina I, Gore Joel M, Goldberg Robert J
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (H.Y.C., M.T., K.L.L., J.Y., S.D.P., C.I.K., J.M.G., R.J.G.).
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (H.Y.C., M.T., K.L.L., J.Y., S.D.P., C.I.K., J.M.G., R.J.G.) Department of Medicine, University of Massachusetts Medical School, Worcester, MA (J.M.G.).
J Am Heart Assoc. 2015 Nov 3;4(11):e002291. doi: 10.1161/JAHA.115.002291.
There are limited data available describing relatively contemporary trends in 30-day rehospitalizations among patients who survive hospitalization after an acute myocardial infarction (AMI) in the community setting. We examined decade-long (2001-2011) trends in, and factors associated with, 30-day rehospitalizations in patients discharged from 3 central Massachusetts hospitals after AMI.
Residents of the Worcester, MA, metropolitan area discharged after AMI from 3 central Massachusetts hospitals on a biennial basis between 2001 and 2011 comprised the study population (N=4810). Logistic regression analyses were used to examine the association between selected factors and 30-day rehospitalizations. The average age of this population was 69 years, 42% were women, and 92% were white. During the years under study, 18.5% of patients were rehospitalized within 30 days after hospital discharge. Crude 30-day rehospitalization rates decreased from 20.5% in 2001-2003 to 15.8% in 2009-2011. After adjusting for several patient characteristics, there was a reduced odds of being rehospitalized in 2009-2011 (odds ratio 0.74, 95% CI 0.61-0.91) compared with 2001-2003; this trend was slightly attenuated after further adjustment for hospital treatment practices. Female sex, having previously diagnosed heart failure and chronic kidney disease, and the development of in-hospital cardiogenic shock and heart failure were associated with an increased odds of being rehospitalized.
While the likelihood of subsequent short-term rehospitalizations remained frequent, we observed an encouraging decline during the most recent years under study. Several high-risk groups were identified for purposes of heightened surveillance and intervention efforts to reduce the likelihood of being readmitted.
在社区环境中，急性心肌梗死（AMI）住院存活患者30天再住院的相对现代趋势的可用数据有限。我们研究了马萨诸塞州中部3家医院AMI后出院患者30天再住院的十年（2001 - 2011年）趋势及相关因素。
2001年至2011年期间，马萨诸塞州伍斯特市大都会地区在马萨诸塞州中部3家医院AMI后出院的居民构成研究人群（N = 4810）。采用逻辑回归分析来检验选定因素与30天再住院之间的关联。该人群的平均年龄为69岁，42%为女性，92%为白人。在研究期间，18.5%的患者在出院后30天内再次住院。30天再住院的粗率从2001 - 2003年的20.5%降至2009 - 2011年的15.8%。在调整了几个患者特征后，与2001 - 2003年相比，2009 - 2011年再住院的几率降低（优势比0.74，95%置信区间0.61 - 0.91）；在进一步调整医院治疗方法后，这一趋势略有减弱。女性、先前诊断为心力衰竭和慢性肾病、住院期间发生心源性休克和心力衰竭与再住院几率增加相关。
虽然随后短期再住院的可能性仍然很高，但在最近的研究年份中我们观察到了令人鼓舞的下降趋势。确定了几个高危组，以便加强监测和干预措施，以降低再次入院的可能性。
