Cholack George, Garfein Joshua, Krallman Rachel, Feldeisen Delaney, Montgomery Daniel, Kline-Rogers Eva, Barnes Geoffrey D, Eagle Kim, Rubenfire Melvyn, Bumpus Sherry
Medical student, MSc. Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI; Oakland University William Beaumont School of Medicine, Rochester, MI, United States.
MPH. Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, United States.
Int J Med Stud. 2022 Jan-Mar;10(1):38-48. doi: 10.5195/ijms.2022.1058.
Readmissions following acute coronary syndrome are unevenly distributed across the 30-day post-discharge period. There is limited data on predictors of all-cause readmission in early (0-7 day) and late (8-30 day) post-discharge periods for this population; the purpose of this retrospective cohort study was to identify predictors of early and late readmission.
Patients at Michigan Medicine (Ann Arbor, Michigan, United States) with a principal discharge diagnosis of unstable angina, ST-segment elevation myocardial infarction, or non-ST segment elevation myocardial infarction between April 2008 and November 2017 were identified. Predictors of early and late readmission were analyzed with multivariable logistic regression models.
Of 1120 patients hospitalized following acute coronary syndrome, 198 (17.68%) were readmitted within 30 days while 70 (6.25%) were readmitted within 7 days of discharge. Of 30-day readmissions, early readmissions were more likely in females [OR 2.26, 95% confidence interval (CI) 1.23, 4.16], non-white individuals (p=0.05), or patients requiring intensive care unit admission during hospitalization (OR 2.20, 95% CI 1.14, 4.24). Relative to patients not readmitted within 7 days, patients who were female, had history of atrial fibrillation, principal discharge diagnosis of non-ST segment elevation myocardial infarction, or required intensive care unit admission were more likely readmitted early. History of congestive heart failure was a predictor of late readmission when compared to patients not readmitted in 30 days.
Following acute coronary syndrome, predictors of readmission varied between early and late readmission groups. Readmission predictors provides healthcare providers with information useful in minimizing readmissions and concomitant financial penalties.
急性冠状动脉综合征后的再入院情况在出院后的30天内分布不均。关于该人群出院早期（0 - 7天）和晚期（8 - 30天）全因再入院预测因素的数据有限；这项回顾性队列研究的目的是确定早期和晚期再入院的预测因素。
确定了2008年4月至2017年11月期间在美国密歇根大学医学中心（密歇根州安娜堡）出院主要诊断为不稳定型心绞痛、ST段抬高型心肌梗死或非ST段抬高型心肌梗死的患者。使用多变量逻辑回归模型分析早期和晚期再入院的预测因素。
在1120例因急性冠状动脉综合征住院的患者中，198例（17.68%）在30天内再次入院，70例（6.25%）在出院后7天内再次入院。在30天再入院患者中，女性（比值比[OR]2.26，95%置信区间[CI]1.23，4.16）、非白人个体（p = 0.05）或住院期间需要入住重症监护病房的患者（OR 2.20，95% CI 1.14，4.24）更有可能早期再入院。与7天内未再入院的患者相比，女性、有房颤病史、出院主要诊断为非ST段抬高型心肌梗死或需要入住重症监护病房的患者更有可能早期再入院。与30天内未再入院的患者相比，充血性心力衰竭病史是晚期再入院的预测因素。
急性冠状动脉综合征后，早期和晚期再入院组的再入院预测因素不同。再入院预测因素为医疗服务提供者提供了有助于减少再入院及相关经济处罚的有用信息。
