Khera Rohan, Jain Snigdha, Pandey Ambarish, Agusala Vijay, Kumbhani Dharam J, Das Sandeep R, Berry Jarett D, de Lemos James A, Girotra Saket
Division of Cardiology, UT Southwestern Medical Center, Dallas, Texas.
Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas.
Am J Cardiol. 2017 Nov 15;120(10):1761-1767. doi: 10.1016/j.amjcard.2017.07.081. Epub 2017 Aug 4.
Postacute myocardial infarction (AMI) readmissions are common among Medicare beneficiaries (≥65 years) and are associated with significant resource utilization. However, patterns of AMI readmissions for younger age groups in the United States are not known. In the Nationwide Readmissions Database, a nationally representative all-payer database of inpatient hospitalizations, we identified 212,171 index AMI hospitalizations in January to November 2013, weighted to represent 478,247 hospitalizations nationally (mean age 66.9 years, 38% women, 29% low income). This included 26,516 cases in the 18 to 44 age group, 183,703 in the 45 to 64 age group, and 268,027 in the ≥65 age group. The overall 30-day readmission rate was 14.5% and varied across age groups (9.7% [18 to 44], 11.2% [45 to 64], and 17.3% [≥65]). The cumulative cost of 30-day readmissions was $1.1 billion, of which $365 million was spent on those <65 years of age. In multivariable hierarchical models, the risk of readmission was higher in women and in low-income patients, but the effect varied by age (p value for age-gender and age-income interactions <0.05) and was more prominent in the younger age groups. Further, patients in all age groups continue to have a high hospitalization burden beyond the typical 30-day readmission period, with an overall 24% post-AMI 90-day readmission rate. In conclusion, readmissions in young and middle-aged AMI survivors pose a substantial burden on patients and on U.S. health-care resources. Women and low-income patients with AMI, particularly those in younger age groups, are more frequently readmitted, and readmissions continue to burden the health-care system beyond the typical 30-day window. Future investigations would need to be targeted toward a better understanding and improvement of the rehospitalization burden for vulnerable patient groups.
急性心肌梗死（AMI）再入院在医疗保险受益人（≥65岁）中很常见，且与大量资源利用相关。然而，美国较年轻年龄组的AMI再入院模式尚不清楚。在全国再入院数据库（一个具有全国代表性的住院患者全支付方数据库）中，我们确定了2013年1月至11月期间212,171例首次AMI住院病例，经加权后代表全国478,247例住院病例（平均年龄66.9岁，38%为女性，29%为低收入）。这包括18至44岁年龄组的26,516例病例、45至64岁年龄组的183,703例病例以及≥65岁年龄组的268,027例病例。总体30天再入院率为14.5%，且在不同年龄组中有所差异（18至44岁为9.7%，45至64岁为11.2%，≥65岁为17.3%）。30天再入院的累计费用为11亿美元，其中3.65亿美元用于65岁以下人群。在多变量分层模型中，女性和低收入患者的再入院风险较高，但这种影响因年龄而异（年龄与性别、年龄与收入交互作用的p值<0.05），且在较年轻年龄组中更为显著。此外，所有年龄组的患者在典型的30天再入院期之后仍有较高的住院负担，AMI后90天的总体再入院率为24%。总之，年轻和中年AMI幸存者的再入院给患者和美国医疗资源带来了沉重负担。患有AMI的女性和低收入患者，尤其是较年轻年龄组的患者，更频繁地再入院，并且再入院在典型的30天窗口之后仍继续给医疗系统带来负担。未来的调查需要针对更好地理解和改善弱势群体的再次住院负担。
