Agrawal Yashwant, Panaich Sidakpal, Aggarwal Sourabh, Saltiel Frank, Kalavakunta Jagadeesh K, Gupta Vishal
Department of Internal Medicine & Pediatrics/Internal Medicine, Western Michigan University Homer Stryker School of Medicine, Kalamazoo, MI, USA.
Department of Interventional Cardiology, Borgess Medical Center/Michigan State University, Kalamazoo, MI, USA.
Int J Cardiol. 2016 Jul 1;214:408-9. doi: 10.1016/j.ijcard.2016.03.227. Epub 2016 Apr 6.
Acute myocardial infarction (AMI) is the most common cause of mortality in the USA as per the data released by the CDC. Short term hospital readmissions account for a significant portion of health care budget and much of the focus recently has been on reducing 30day readmission rate aimed to identify the demographics associated with readmissions from AMI and major causes of readmissions.
We queried the Nationwide Inpatient Sample which represents 20% of all the United States hospital data for our study. AMI was identified through ICD9 Clinical Classification Software Code 100 for readmissions secondary to AMI for years 2009-2013. Chi-square was used for statistical analysis.
A total of 2,371,867 admissions were identified with AMI and 15.87% of these readmitted within 30days after index hospitalizations due to any cause. Patients with age greater than 65years, female gender, Medicare and Medicaid insurances, low median income for zip code and metropolitan areas were associated with high 30day readmission rate. The most common identified cause of readmission from 2009-2011 was coronary atherosclerosis (15%) and from 2012-2013 the cause identified was congestive heart failure (13.5%) (p<0.001).
Aggressive medical management needs to be targeted at this demography of patients and prevent the most causes of readmissions to reduce the cost and morbidity of patients admitted with AMI.
根据美国疾病控制与预防中心(CDC)发布的数据,急性心肌梗死(AMI)是美国最常见的死亡原因。短期住院再入院占医疗保健预算的很大一部分,最近很多关注都集中在降低30天再入院率上,旨在确定与AMI再入院相关的人口统计学特征以及再入院的主要原因。
我们查询了代表美国所有医院数据20%的全国住院患者样本用于我们的研究。通过ICD9临床分类软件代码100识别2009 - 2013年因AMI继发的再入院患者中的AMI。采用卡方检验进行统计分析。
共识别出2371867例AMI入院患者,其中15.87%在首次住院后的30天内因任何原因再次入院。年龄大于65岁、女性、医疗保险和医疗补助保险、邮政编码和大都市地区的低收入中位数与30天再入院率高相关。2009 - 2011年确定的最常见再入院原因是冠状动脉粥样硬化(15%),2012 - 2013年确定的原因是充血性心力衰竭(13.5%)(p<0.001)。
需要针对这类患者群体采取积极的医疗管理措施,预防最主要的再入院原因,以降低AMI入院患者的成本和发病率。