1 Department of Cardiology Heart and Vascular Institute Center for Healthcare Delivery Innovation Cleveland OH.
2 Department of Quantitative Health Sciences Research Institute Cleveland OH.
J Am Heart Assoc. 2018 Nov 6;7(21):e009650. doi: 10.1161/JAHA.118.009650.
Background Readmission after myocardial infarction ( MI ) is a publicly reported quality metric with hospital reimbursement linked to readmission rates. We describe the timing and pattern of readmission by cause within the first year after MI in consecutive patients, regardless of revascularization strategy, payer status, or age. Methods and Results We identified patients discharged after an MI from April 2008 to June 2012. Readmission within 12 months was the primary end point. Readmissions were classified into 4 groups: MI related, other cardiovascular, noncardiovascular, and planned. A total of 3069 patients were discharged after an MI (average age, 65±13 years; and 1941 [63%] men). A total of 655 patients (21.3%) were readmitted at least once (897 total readmissions). A total of 147 patients (4.8%) were readmitted ≥2 times, accounting for 389 readmissions (43%). The instantaneous risk of all-cause readmission was highest (15 readmissions/100 patients per month; 95% confidence interval, 12-19 readmissions/100 patients per month) immediately after discharge, decreased by almost half (8.1 readmissions/100 patients per month; 95% confidence interval, 7.2-9.0 readmissions/100 patients per month) within 15 days, and was substantially lower and relatively constant (1.4 readmissions/100 patients per month; 95% confidence interval, 1.2-1.6 readmissions/100 patients per month) out to 1 year. Cardiovascular causes of readmission were more common early after discharge. Conclusions Most patients with MI are never readmitted, whereas a small minority (≈5%) account for nearly half of 1-year readmissions. The readmission pattern after MI is characterized by an early peak (first 15 days) of cardiovascular readmissions, followed by a middle period (months 1-4) of noncardiovascular readmissions, and ending with a low-risk period (>4 months) during which the risk appears independent of cause.
背景 心肌梗死后（MI）再入院是一个公开报告的质量指标，与再入院率相关的医院报销。我们描述了在 MI 后 1 年内，无论血管重建策略、支付者状态或年龄如何，因病因导致的再入院的时间和模式。
方法和结果 我们从 2008 年 4 月至 2012 年 6 月期间确定了 MI 出院后的患者。12 个月内再入院是主要终点。将再入院分为 4 组：MI 相关、其他心血管、非心血管和计划。共有 3069 例 MI 患者出院（平均年龄 65±13 岁；1941 例[63%]为男性）。共有 655 例患者（21.3%）至少一次再入院（共 897 次再入院）。共有 147 例患者（4.8%）再入院≥2 次，占 389 次再入院（43%）。所有原因再入院的瞬时风险最高（15 例/100 例患者/月；95%置信区间，12-19 例/100 例患者/月），出院后立即下降近一半（8.1 例/100 例患者/月；95%置信区间，7.2-9.0 例/100 例患者/月），在 15 天内显著降低且相对稳定（1.4 例/100 例患者/月；95%置信区间，1.2-1.6 例/100 例患者/月），直至 1 年。心血管原因导致的再入院在出院后早期更为常见。
结论 大多数 MI 患者从未再入院，而少数（约 5%）患者占 1 年再入院人数的近一半。MI 后的再入院模式的特点是早期（第 15 天内）心血管再入院高峰，随后是中期（1-4 个月）非心血管再入院，最后是低风险期（>4 个月），在此期间，风险似乎与病因无关。
