Affiliation:
1. Department of Biostatistics Harvard T.H. Chan School of Public Health Boston MA
2. Center for Outcomes Research and Evaluation Yale‐New Haven Hospital New Haven CT
3. Department of Chronic Disease Epidemiology Yale School of Public Health New Haven CT
4. Department of Health Care Policy Harvard Medical School Boston MA
5. Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT
6. Department of Health Policy and Management Yale School of Public Health New Haven CT
Abstract
Background
Patients who survive acute myocardial infarction (
AMI
) are at high risk for recurrence. We determined whether rehospitalizations after
AMI
further increased risk of recurrent
AMI
.
Methods and Results
The study included Medicare fee‐for‐service patients aged ≥65 years discharged alive after
AMI
from acute‐care hospitals in fiscal years 2009–2014. The outcome was recurrent
AMI
within 1 year of the index
AMI
. The Clinical Classifications Software (
CCS
) was used to classify rehospitalizations into disease categories. A Cox regression model was fit accounting for
CCS
‐specific hospitalizations as time‐varying variables and patient characteristics at discharge for the index
AMI
, adjusting for the competing risk of death. The rate of 1‐year recurrent
AMI
was 5.3% (95%
CI
, 5.27%–5.41%), and median (interquartile range) time from discharge to recurrent
AMI
was 115 (34–230) days. Eleven disease categories (diabetes mellitus, anemia, hypertension, coronary atherosclerosis, chest pain, heart failure, pneumonia, chronic obstructive pulmonary disease, gastrointestinal hemorrhage, renal failure, complication of implant or graft) were associated with increased risk of recurrent
AMI
. Septicemia was associated with lower recurrence risk. Hazard ratios ranged from 1.6 (95%
CI
, 1.55–1.70, heart failure) to 1.1 (95%
CI
, 1.04–1.25, pneumonia) to 0.6 (95%
CI
, 0.58–0.71, septicemia).
Conclusions
Patient risk of recurrent
AMI
changed based on the occurrence of hospitalizations after the index
AMI
. Improving post–acute care to prevent unplanned rehospitalizations, especially rehospitalizations for chronic diseases, and extending the focus of outcomes measures to condition‐specific rehospitalizations within 30 days and beyond is important for the secondary prevention of
AMI
.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
17 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献