Long-Term Hospital Readmission after ST-Elevation Myocardial Infarction: A 3-Year Follow-up from the SEMI-CI Study
-
Parsa Tavassoli Naini
,
Marjan Jamalian
,
Ali Riahi
,
Hamid Reza Roohafza
,
Mohammadreza Shafiei
,
Mohammad Agharazi
,
Masoumeh Sadeghi
Abstract
Background. This study aimed to investigate readmission risk factors after ST-elevation myocardial infarction (STEMI) during a 3-year follow-up.
Methods: This study is a secondary analysis of the STEMI Cohort Study (SEMI-CI) in Isfahan, Iran, with 867 patients. A trained nurse gathered the demographic, medical history, laboratory, and clinical data at discharge. Then the patients were followed up annually for 3 years by telephone and invitation for in-person visits with a cardiologist concerning readmission status. Cardiovascular readmission was defined as MI, unstable angina, stent thrombosis, stroke, and heart failure. Adjusted and unadjusted binary logistic regression analyses were applied.
Results: Of 773 patients with complete information, 234 patients (30.27%) experienced 3-year readmission. The mean age of the patients was 60.92±12.77 years, and 705 patients (81.3%) were males. The unadjusted results showed that smokers were 21% more likely to be readmitted than nonsmokers (OR, 1.21; P=0.015). Readmitted patients had a 26% lower shock index (OR, 0.26; P=0.047), and ejection fraction had a conservative effect (OR, 0.97; P<0.05). The creatinine level was 68% higher in patients with readmission. An adjusted model based on age and sex showed that the creatinine level (OR, 1.73), the shock index (OR, 0.26), heart failure (OR, 1.78), and ejection fraction (OR, 0.97) were significantly different between the 2 groups.
Conclusion: Patients at risk of readmission should be identified and carefully visited by specialists to help improve timely treatment and reduce readmissions. Therefore, it is recommended to pay special attention to factors affecting readmission in the routine visits of STEMI patients.
1. Bahall M, Khan K. Quality of life of patients with first-time AMI: a descriptive study. Health Qual Life Outcomes 2018;16:32.
2. Salarifar M, Askari J, Saadat M, Geraiely B, Omid N, Poorhosseini H, Amirzadegan A, Hajzeinali A, Alidoosti M, Aghajani H, Nozari Y, Nematipoor E. Strategies to Reduce the Door-to-Device Time in ST-Elevation Myocardial Infarction Patients. J Tehran Heart Cent 2019;14:18-27.
3. Saadatagah S, Ghodsi S, Omidi N, Poorhosseini H, Salarifar M, Sadeghian S, Alidoosti M, Kassaian SE, Aghajani H, Mortazavi SH, Hosseini K, Geraiely B. Twelve-Year History of STEMI Management in Tehran Heart Center: Concomitant Reduction of In-Hospital Mortality and Hospitalization Length. Arch Iran Med 2020;23:514-521.
4. Hosseini K, Mortazavi SH, Sadeghian S, Ayati A, Nalini M, Aminorroaya A, Tavolinejad H, Salarifar M, Pourhosseini H, Aein A, Jalali A, Bozorgi A, Mehrani M, Kamangar F. Prevalence and trends of coronary artery disease risk factors and their effect on age of diagnosis in patients with established coronary artery disease: Tehran Heart Center (2005-2015). BMC Cardiovasc Disord 2021;21:477.
5. Janjani P, Motevaseli S, Salehi N, Heidari Moghadam R, Siabani S, Nalini M. Predictors of 1-Year Major Cardiovascular Events after ST-Elevation Myocardial Infarction in a Specialized Cardiovascular Center in Western Iran. J Tehran Heart Cent 2022;17:62-70.
6. Fingar K, Washington R. Trends in Hospital Readmissions for Four High-Volume Conditions, 2009–2013. 2015 Nov. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006 Feb–. Statistical Brief #196.
7. Pandey A, Golwala H, Hall HM, Wang TY, Lu D, Xian Y, Chiswell K, Joynt KE, Goyal A, Das SR, Kumbhani D, Julien H, Fonarow GC, de Lemos JA. Association of US Centers for Medicare and Medicaid Services Hospital 30-Day Risk-Standardized Readmission Metric With Care Quality and Outcomes After Acute Myocardial Infarction: Findings From the National Cardiovascular Data Registry/Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines. JAMA Cardiol 2017;2:723-731.
8. Nguyen OK, Makam AN, Clark C, Zhang S, Das SR, Halm EA. Predicting 30-Day Hospital Readmissions in Acute Myocardial Infarction: The AMI "READMITS" (Renal Function, Elevated Brain Natriuretic Peptide, Age, Diabetes Mellitus, Nonmale Sex, Intervention with Timely Percutaneous Coronary Intervention, and Low Systolic Blood Pressure) Score. J Am Heart Assoc 2018;7:e008882.
9. Kini V, Peterson PN, Spertus JA, Kennedy KF, Arnold SV, Wasfy JH, Curtis JP, Bradley SM, Amin AP, Ho PM, Masoudi FA. Clinical Model to Predict 90-Day Risk of Readmission After Acute Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2018;11:e004788.
10. Khot UN, Johnson MJ, Wiggins NB, Lowry AM, Rajeswaran J, Kapadia S, Menon V, Ellis SG, Goepfarth P, Blackstone EH. Long-Term Time-Varying Risk of Readmission After Acute Myocardial Infarction. J Am Heart Assoc 2018;7:e009650.
11. Kim LK, Yeo I, Cheung JW, Swaminathan RV, Wong SC, Charitakis K, Adejumo O, Chae J, Minutello RM, Bergman G, Singh H, Feldman DN. Thirty-Day Readmission Rates, Timing, Causes, and Costs after ST-Segment-Elevation Myocardial Infarction in the United States: A National Readmission Database Analysis 2010-2014. J Am Heart Assoc 2018;7:e009863.
12. Roghani-Dehkordi F, Hashemifard O, Sadeghi M, Mansouri R, Akbarzadeh M, Dehghani A, Akbari M. Distal accesses in the hand (two novel techniques) for percutaneous coronary angiography and intervention. ARYA Atheroscler 2018;14:95-100.
13. DeMers D, Wachs D. Physiology, Mean Arterial Pressure. [Updated 2022 Apr 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538226/(04 June 2022).
14. Abreu G, Azevedo P, Galvão Braga C, Vieira C, Álvares Pereira M, Martins J, Arantes C, Rodrigues C, Salgado A, Marques J. Modified shock index: A bedside clinical index for risk assessment of ST-segment elevation myocardial infarction at presentation. Rev Port Cardiol (Engl Ed) 2018;37:481-488.
15. Yu T, Tian C, Song J, He D, Sun Z, Sun Z. Age Shock Index is Superior to Shock Index and Modified Shock Index for Predicting Long-Term Prognosis in Acute Myocardial Infarction. Shock 2017;48:545-550.
16. Wang H, Zhao T, Wei X, Lu H, Lin X. The prevalence of 30-day readmission after acute myocardial infarction: A systematic review and meta-analysis. Clin Cardiol 2019;42:889-898.
17. Andrés E, Cordero A, Magán P, Alegría E, León M, Luengo E, Botaya RM, García Ortiz L, Casasnovas JA. Long-term mortality and hospital readmission after acute myocardial infarction: an eight-year follow-up study. Rev Esp Cardiol (Engl Ed) 2012;65:414-420.
18. Song J, Murugiah K, Hu S, Gao Y, Li X, Krumholz HM, Zheng X; China PEACE Collabortive Group. Incidence, predictors, and prognostic impact of recurrent acute myocardial infarction in China. Heart 2020;107:313–318.
19. Reiss AB, Miyawaki N, Moon J, Kasselman LJ, Voloshyna I, D'Avino R Jr, De Leon J. CKD, arterial calcification, atherosclerosis and bone health: Inter-relationships and controversies. Atherosclerosis 2018;278:49-59.
20. Emamian MH, Fateh M, Fotouhi A. Socioeconomic inequality in smoking and its determinants in the Islamic Republic of Iran. East Mediterr Health J 2020;26:29-38.
21. Wang SL, Wang CL, Wang PL, Xu H, Du JP, Zhang DW, Gao ZY, Zhang L, Fu CG, Chen KJ, Shi DZ. Resting heart rate associates with one-year risk of major adverse cardiovascular events in patients with acute coronary syndrome after percutaneous coronary intervention. Exp Biol Med (Maywood) 2016;241:478-84.
22. Sun N, Chen Y, Xi Y, Wang H, Wang L. Association Between Heart Rate and Major Adverse Cardiovascular Events Among 9,991 Hypertentive Patients: A Multicenter Retrospective Follow-Up Study. Front Cardiovasc Med 2021;8:741784.
23. Okkonen M, Havulinna AS, Ukkola O, Huikuri H, Pietilä A, Koukkunen H, Lehto S, Mustonen J, Ketonen M, Airaksinen J, Kesäniemi YA, Salomaa V. Risk factors for major adverse cardiovascular events after the first acute coronary syndrome. Ann Med 2021;53:817-823.
24. Vitale C, Spoletini I, Rosano GM. Frailty in Heart Failure: Implications for Management. Card Fail Rev 2018;4:104-106.
25. Braunwald E. Diabetes, heart failure, and renal dysfunction: The vicious circles. Prog Cardiovasc Dis 2019;62:298-302.
26. Cuomo A, Paudice F, D'Angelo G, Perrotta G, Carannante A, Attanasio U, Iengo M, Fiore F, Tocchetti CG, Mercurio V, Pirozzi F. New-Onset Cancer in the HF Population: Epidemiology, Pathophysiology, and Clinical Management. Curr Heart Fail Rep 2021;18:191-199.
27. Park JJ. Epidemiology, Pathophysiology, Diagnosis and Treatment of Heart Failure in Diabetes. Diabetes Metab J 2021;45:146-157.
28. Reinstadler SJ, Fuernau G, Eitel C, de Waha S, Desch S, Metzler B, Schuler G, Thiele H, Eitel I. Shock Index as a Predictor of Myocardial Damage and Clinical Outcome in ST-Elevation Myocardial Infarction. Circ J 2016;80:924-930.
29. Hietanen C. Calculated decisions: Shock index, pediatric age-adjusted (SIPA). Pediatr Emerg Med Pract 2020;17(Suppl 1):CD6-CD7.
2. Salarifar M, Askari J, Saadat M, Geraiely B, Omid N, Poorhosseini H, Amirzadegan A, Hajzeinali A, Alidoosti M, Aghajani H, Nozari Y, Nematipoor E. Strategies to Reduce the Door-to-Device Time in ST-Elevation Myocardial Infarction Patients. J Tehran Heart Cent 2019;14:18-27.
3. Saadatagah S, Ghodsi S, Omidi N, Poorhosseini H, Salarifar M, Sadeghian S, Alidoosti M, Kassaian SE, Aghajani H, Mortazavi SH, Hosseini K, Geraiely B. Twelve-Year History of STEMI Management in Tehran Heart Center: Concomitant Reduction of In-Hospital Mortality and Hospitalization Length. Arch Iran Med 2020;23:514-521.
4. Hosseini K, Mortazavi SH, Sadeghian S, Ayati A, Nalini M, Aminorroaya A, Tavolinejad H, Salarifar M, Pourhosseini H, Aein A, Jalali A, Bozorgi A, Mehrani M, Kamangar F. Prevalence and trends of coronary artery disease risk factors and their effect on age of diagnosis in patients with established coronary artery disease: Tehran Heart Center (2005-2015). BMC Cardiovasc Disord 2021;21:477.
5. Janjani P, Motevaseli S, Salehi N, Heidari Moghadam R, Siabani S, Nalini M. Predictors of 1-Year Major Cardiovascular Events after ST-Elevation Myocardial Infarction in a Specialized Cardiovascular Center in Western Iran. J Tehran Heart Cent 2022;17:62-70.
6. Fingar K, Washington R. Trends in Hospital Readmissions for Four High-Volume Conditions, 2009–2013. 2015 Nov. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006 Feb–. Statistical Brief #196.
7. Pandey A, Golwala H, Hall HM, Wang TY, Lu D, Xian Y, Chiswell K, Joynt KE, Goyal A, Das SR, Kumbhani D, Julien H, Fonarow GC, de Lemos JA. Association of US Centers for Medicare and Medicaid Services Hospital 30-Day Risk-Standardized Readmission Metric With Care Quality and Outcomes After Acute Myocardial Infarction: Findings From the National Cardiovascular Data Registry/Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines. JAMA Cardiol 2017;2:723-731.
8. Nguyen OK, Makam AN, Clark C, Zhang S, Das SR, Halm EA. Predicting 30-Day Hospital Readmissions in Acute Myocardial Infarction: The AMI "READMITS" (Renal Function, Elevated Brain Natriuretic Peptide, Age, Diabetes Mellitus, Nonmale Sex, Intervention with Timely Percutaneous Coronary Intervention, and Low Systolic Blood Pressure) Score. J Am Heart Assoc 2018;7:e008882.
9. Kini V, Peterson PN, Spertus JA, Kennedy KF, Arnold SV, Wasfy JH, Curtis JP, Bradley SM, Amin AP, Ho PM, Masoudi FA. Clinical Model to Predict 90-Day Risk of Readmission After Acute Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2018;11:e004788.
10. Khot UN, Johnson MJ, Wiggins NB, Lowry AM, Rajeswaran J, Kapadia S, Menon V, Ellis SG, Goepfarth P, Blackstone EH. Long-Term Time-Varying Risk of Readmission After Acute Myocardial Infarction. J Am Heart Assoc 2018;7:e009650.
11. Kim LK, Yeo I, Cheung JW, Swaminathan RV, Wong SC, Charitakis K, Adejumo O, Chae J, Minutello RM, Bergman G, Singh H, Feldman DN. Thirty-Day Readmission Rates, Timing, Causes, and Costs after ST-Segment-Elevation Myocardial Infarction in the United States: A National Readmission Database Analysis 2010-2014. J Am Heart Assoc 2018;7:e009863.
12. Roghani-Dehkordi F, Hashemifard O, Sadeghi M, Mansouri R, Akbarzadeh M, Dehghani A, Akbari M. Distal accesses in the hand (two novel techniques) for percutaneous coronary angiography and intervention. ARYA Atheroscler 2018;14:95-100.
13. DeMers D, Wachs D. Physiology, Mean Arterial Pressure. [Updated 2022 Apr 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538226/(04 June 2022).
14. Abreu G, Azevedo P, Galvão Braga C, Vieira C, Álvares Pereira M, Martins J, Arantes C, Rodrigues C, Salgado A, Marques J. Modified shock index: A bedside clinical index for risk assessment of ST-segment elevation myocardial infarction at presentation. Rev Port Cardiol (Engl Ed) 2018;37:481-488.
15. Yu T, Tian C, Song J, He D, Sun Z, Sun Z. Age Shock Index is Superior to Shock Index and Modified Shock Index for Predicting Long-Term Prognosis in Acute Myocardial Infarction. Shock 2017;48:545-550.
16. Wang H, Zhao T, Wei X, Lu H, Lin X. The prevalence of 30-day readmission after acute myocardial infarction: A systematic review and meta-analysis. Clin Cardiol 2019;42:889-898.
17. Andrés E, Cordero A, Magán P, Alegría E, León M, Luengo E, Botaya RM, García Ortiz L, Casasnovas JA. Long-term mortality and hospital readmission after acute myocardial infarction: an eight-year follow-up study. Rev Esp Cardiol (Engl Ed) 2012;65:414-420.
18. Song J, Murugiah K, Hu S, Gao Y, Li X, Krumholz HM, Zheng X; China PEACE Collabortive Group. Incidence, predictors, and prognostic impact of recurrent acute myocardial infarction in China. Heart 2020;107:313–318.
19. Reiss AB, Miyawaki N, Moon J, Kasselman LJ, Voloshyna I, D'Avino R Jr, De Leon J. CKD, arterial calcification, atherosclerosis and bone health: Inter-relationships and controversies. Atherosclerosis 2018;278:49-59.
20. Emamian MH, Fateh M, Fotouhi A. Socioeconomic inequality in smoking and its determinants in the Islamic Republic of Iran. East Mediterr Health J 2020;26:29-38.
21. Wang SL, Wang CL, Wang PL, Xu H, Du JP, Zhang DW, Gao ZY, Zhang L, Fu CG, Chen KJ, Shi DZ. Resting heart rate associates with one-year risk of major adverse cardiovascular events in patients with acute coronary syndrome after percutaneous coronary intervention. Exp Biol Med (Maywood) 2016;241:478-84.
22. Sun N, Chen Y, Xi Y, Wang H, Wang L. Association Between Heart Rate and Major Adverse Cardiovascular Events Among 9,991 Hypertentive Patients: A Multicenter Retrospective Follow-Up Study. Front Cardiovasc Med 2021;8:741784.
23. Okkonen M, Havulinna AS, Ukkola O, Huikuri H, Pietilä A, Koukkunen H, Lehto S, Mustonen J, Ketonen M, Airaksinen J, Kesäniemi YA, Salomaa V. Risk factors for major adverse cardiovascular events after the first acute coronary syndrome. Ann Med 2021;53:817-823.
24. Vitale C, Spoletini I, Rosano GM. Frailty in Heart Failure: Implications for Management. Card Fail Rev 2018;4:104-106.
25. Braunwald E. Diabetes, heart failure, and renal dysfunction: The vicious circles. Prog Cardiovasc Dis 2019;62:298-302.
26. Cuomo A, Paudice F, D'Angelo G, Perrotta G, Carannante A, Attanasio U, Iengo M, Fiore F, Tocchetti CG, Mercurio V, Pirozzi F. New-Onset Cancer in the HF Population: Epidemiology, Pathophysiology, and Clinical Management. Curr Heart Fail Rep 2021;18:191-199.
27. Park JJ. Epidemiology, Pathophysiology, Diagnosis and Treatment of Heart Failure in Diabetes. Diabetes Metab J 2021;45:146-157.
28. Reinstadler SJ, Fuernau G, Eitel C, de Waha S, Desch S, Metzler B, Schuler G, Thiele H, Eitel I. Shock Index as a Predictor of Myocardial Damage and Clinical Outcome in ST-Elevation Myocardial Infarction. Circ J 2016;80:924-930.
29. Hietanen C. Calculated decisions: Shock index, pediatric age-adjusted (SIPA). Pediatr Emerg Med Pract 2020;17(Suppl 1):CD6-CD7.
| Files | ||
| Issue | Vol 17 No 4 (2022): J Teh Univ Heart Ctr | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jthc.v17i4.11612 | |
| Keywords | ||
| ST-elevation myocardial infarction Hospital readmission Risk factors | ||
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How to Cite
1.
Tavassoli Naini P, Jamalian M, Riahi A, Roohafza HR, Shafiei M, Agharazi M, Sadeghi M. Long-Term Hospital Readmission after ST-Elevation Myocardial Infarction: A 3-Year Follow-up from the SEMI-CI Study. J Tehran Heart Cent. 2022;17(4):230-235.
