Heart Attacks Are Harder

Heart attack patients may be more likely to be admitted to a hospital

(RxWiki News) Patients aren't always out of the woods after hospital release following a heart attack. Many are readmitted later the same month after complications. Americans may be at a higher risk of readmission as compared to Canadian and European patients.

U.S. ST-segment elevation myocardial infarction patients, a common type of heart attack known as STEMI, were found to have higher hospital readmission rates at 30 days as compared to residents of more than 15 other countries. STEMI accounts for up to 38 percent of all heart attacks.

"Manage hypertension and high cholesterol to lower heart attack risk."

Dr. Robb D. Kociol, of Duke University Medical Center, noted that while patients are more likely to survive until hospital discharge as procedures such as angioplasty to open blocked arteries have improved, they appear to be at risk for early hospital readmission.

During the study researchers analyzed data from the Assessment of Pexelizumab in Acute Myocardial Infarction study, a large multinational clinical trial. That trial enrolled 5,745 patients with STEMI in the U.S., Canada, Australia, New Zealand and 13 European countries between July 2004 and May 2006.

Investigators reviewed the records to identify the causes of readmission within 30 days of patient's heart attacks.

Of the participants, 97 percent survived until hospital discharge with 11.3 percent later readmitted within 30 days of hospital discharge. Factors associated with a higher chance of being readmitted included multi-vessel coronary artery disease, baseline heart rate and U.S. residency as compared to patients in other countries.

Those with multi-vessel disease were twice as likely to be readmitted as compared to patients without it, while baseline heart rate per 10/minute increased readmission by 9 percent.

U.S. patients were found 68 percent more likely to be readmitted versus patients from other countries. At 30 days, the readmission rate in the U.S. was 14.5 percent compared to 9.9 percent among other countries. Americans also had shorter average hospital stays at three days, while Germany had the longest at eight days. When adjusted for median hospital stay lengths, investigators found that U.S. location no longer was a factor.

Other readmission predictors included recurrent ischemia, chronic obstructive pulmonary disease, chronic inflammatory conditions, and a history of hypertension.

"Our analysis shows that readmission may be preventable because rates are nearly one-third lower in other countries, suggesting that the U.S. health care system has features that can be modified to decrease readmission rates," researchers wrote.

"Understanding these international differences may provide important insight into reducing such rates, particularly in the United States."

The study, which had no reported conflicts, was published in the Jan. 4 edition of the Journal of the American Medical Association.

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Review Date: 
January 5, 2012