Association Between Subsequent Hospitalizations and Recurrent Acute Myocardial Infarction Within 1 Year After Acute Myocardial Infarction

Author:

Wang Yun12,Leifheit Erica3,Normand Sharon‐Lise T.14,Krumholz Harlan M.256ORCID

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

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