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Patients with STEMI have higher hospital readmission rates in US than other countries
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Patients in the United States who experienced a STEMI were more likely to be readmitted to the hospital at 30 days than patients in other countries, according to a post hoc analysis.
The Assessment of Pexelizumab in Acute MI study enrolled 5,745 patients with STEMI at 296 sites in the United States, Australia, Canada, New Zealand and 13 European countries from July 2004 to May 2006. Analysis was performed to identify predictors of all-cause and nonelective 30-day postdischarge hospital readmission. The post hoc analysis included 5,571 of the enrolled patients who survived to hospital discharge and represented 17 countries. Of those patients, 11.3% (n=631) were readmitted within 30 days of hospital discharge.
Varying readmission rates
Thirty-day readmission rates were higher for patients in the United States than in the other countries (14.5% vs. 9.9%; P<.001). “Excluding readmissions for elective revascularization, 8.6% of patients in the overall cohort were readmitted within 30 days of discharge, accounting for 10.5% of patients in the United States and 7.7% of patients outside the United States,” the researchers wrote.
Odds of 30-day readmission varied per country. Compared with the United States, countries with a significantly lower odds of readmission included Italy (OR=0.26; 95% CI, 0.15-0.43), Germany (OR=0.28; 95% CI, 0.07-0.46), Canada (OR=0.33; 95% CI, 0.20-0.56) and Portugal (OR=0.41; 95% CI, 0.21-0.80). Only Denmark and Sweden had higher odds of readmission, but this finding was not statistically significant.
Overall, the median length of hospital stay was shortest for US patients (3 days) and longest for German patients (8 days).
Factors associated with readmission
Predictors of 30-day readmission included multivessel CAD (OR=1.97; 95% CI, 1.65-2.35) and US location (OR=1.68; 95% CI, 1.37-2.07), according to multivariable regression. US location remained an independent predictor of readmission (OR=1.53; 95% CI, 1.20-1.96), excluding elective readmission. However, after adjusting for country-level median length of stay, US location was no longer an independent predictor of all-cause or nonelective readmission. “Location in the United States was not a predictor of in-hospital death or 30-day postadmission death,” the researchers wrote.
Other independent predictors of readmission included:
- Noninferior MI location (OR=1.28; 95% CI, 1.07-1.52).
- Recurrent ischemia (OR=1.28; 95% CI, 1.01-2.47).
- Chronic obstructive pulmonary disease (OR=1.51; 95% CI, 1.07-2.14).
- Chronic inflammatory conditions (OR=1.75; 95% CI, 1.04-2.94).
- History of hypertension (OR=1.28; 95% CI, 1.07-1.52).
Patients readmitted at 30 days also presented with higher rates of comorbidities, including CAD, hypertension and diabetes. Risk for in-hospital complications such as congestive HF and atrial fibrillation were also higher in those readmitted.
Optimizing international care
The finding that patients with STEMI in the United States have a higher likelihood of 30-day all-cause hospital readmission may be related to differential rates of early readmission for elective revascularization and shorter median length of stay in the United States, according to the researchers.
“Our analysis shows that readmission may be preventable because rates are nearly one-third lower in other countries, suggesting that the US health care system has features that can be modified to decrease readmission rate,” the researchers wrote. “Understanding these international differences may provide important insight into reducing such rates, particularly in the United States.”
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Disclosure: The researchers report no relevant financial disclosures.
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