Vallabhajosyula Saraschandra, Payne Stephanie R, Jentzer Jacob C, Sangaralingham Lindsey R, Kashani Kianoush, Shah Nilay D, Prasad Abhiram, Dunlay Shannon M
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.
Mayo Clin Proc Innov Qual Outcomes. 2021 Feb 8;5(2):320-329. doi: 10.1016/j.mayocpiqo.2020.12.006. eCollection 2021 Apr.
To evaluate post-acute care utilization and readmissions after cardiac arrest (CA) and cardiogenic shock (CS) complicating acute myocardial infarction (AMI).
With use of an administrative claims database, AMI patients from January 1, 2010, to May 31, 2018, were stratified into CA+CS, CA only, CS only, and AMI alone. Outcomes included 90-day post-acute care (inpatient rehabilitation or skilled nursing facility) utilization and 1-year emergency department visits and readmissions.
Of 163,071 AMI patients, CA+CS, CA only, and CS only were noted in 3965 (2.4%), 8221 (5.0%), and 6559 (4.0%), respectively. In-hospital mortality was noted in 10,686 (6.6%) patients: CA+CS, 1935 (48.8%); CA only, 2948 (35.9%); CS only, 1578 (24.1%); and AMI alone, 4225 (2.9%) (<.001). Among survivors, post-acute care services were used in 67,799 (44.5%), with higher use in the CS+CA cohort (1310 [64.6%]; hazard ratio [HR], 1.19; 95% CI, 1.06 to 1.33; =.003) and CA cohort (2738 [51.9%]; HR, 1.27; 95% CI, 1.20 to 1.35; <.001) but not in the CS cohort (3048 [61.2%]; HR, 1.03; 95% CI, 0.97 to 1.11; =.35) compared with the AMI cohort (60,703 [43.3%]). Compared with the AMI cohort (48,990 [35.0%]), patients with CS only (2,085 [41.9%]; HR, 1.16; 95% CI, 1.10 to 1.22; <.001) but not those with CA+CS (724 [35.7%]; HR, 1.07; 95% CI, 0.98 to 1.17; =.14) had higher rates of readmissions (=.03). Readmissions were lower in those with CA (1,590 [30.2%]; HR, 0.94; 95% CI, 0.89 to 0.99). Repeated AMI, coronary artery disease, and heart failure were the most common readmission reasons. There were no differences for emergency department visits.
CA is associated with increased post-acute care use, whereas CS is associated with increased readmission risk in AMI survivors.
评估急性心肌梗死（AMI）合并心脏骤停（CA）和心源性休克（CS）后的急性后期护理利用情况及再入院情况。
利用行政索赔数据库，将2010年1月1日至2018年5月31日的AMI患者分为CA+CS组、单纯CA组、单纯CS组和单纯AMI组。结局指标包括90天急性后期护理（住院康复或专业护理机构）利用情况以及1年急诊科就诊和再入院情况。
在163,071例AMI患者中，CA+CS组、单纯CA组和单纯CS组分别有3965例（2.4%）、8221例（5.0%）和6559例（4.0%）。10,686例（6.6%）患者发生院内死亡：CA+CS组1935例（48.8%）；单纯CA组2948例（35.9%）；单纯CS组1578例（24.1%）；单纯AMI组4225例（2.9%）（P<.001）。在幸存者中，67,799例（44.5%）使用了急性后期护理服务，CS+CA队列（1310例[64.6%]；风险比[HR]，1.19；95%置信区间[CI]，1.06至1.33；P=.003）和CA队列（2738例[51.9%]；HR，1.27；95%CI，1.20至1.35；P<.001）的使用率较高，而与AMI队列（60,703例[43.3%]）相比，CS队列（3048例[61.2%]；HR，1.03；95%CI，0.97至1.11；P=.35）的使用率没有差异。与AMI队列（48,990例[35.0%]）相比，单纯CS患者（2,085例[41.9%]；HR，1.16；95%CI，1.10至1.22；P<.001）的再入院率较高，而CA+CS患者（724例[35.7%]；HR，1.07；95%CI，0.98至1.17；P=.14）则没有差异（P=.03）。CA患者的再入院率较低（1,590例[30.2%]；HR，0.94；95%CI，0.89至0.99）。再次AMI、冠状动脉疾病和心力衰竭是最常见的再入院原因。急诊科就诊情况没有差异。
CA与急性后期护理使用增加相关，而CS与AMI幸存者再入院风险增加相关。
