Hospital readmission for patients who experienced heart attacks are more prevalent in the United States than in other developed nations.
In analysis of more than 15 countries, the United States had the highest rate of hospital readmissions in patients who experienced heart attacks, suggesting that readmissions are indeed preventable, a notion that runs contrary to previous research.
Patients from the United States who suffered an ST-segment elevation myocardial infarction, or STEMI, a certain pattern on an electrocardiogram following a heart attack, had a higher likelihood – 14.5 percent compared to 9.9 percent – of being readmitted to the hospital within 30 days of their heart attack than patients in Canada, Australia and many European countries.
“Our analysis shows that readmission may be preventable because rates are nearly one-third lower in other countries, suggesting that the U.S. healthcare system has features that can be modified to decrease readmission rates,” the study’s authors write. “Understanding these international differences may provide important insight into reducing such rates, particularly in the United States.”
The study was published in the Jan. 4 edition of the Journal of the American Medical Association.
Heart attack with ST-segment elevation accounts for 29 percent to 38 percent of all heart attacks, and although survival has improved dramatically, patients who survive this type of heart attack to hospital discharge are at risk for early postdischarge hospital readmission.
In the United States, 30-day readmission rates for STEMI patients have been proposed as a metric for care and an area for potential cost savings, but previously, international rates and predictors of 30-day readmission after STEMI have not been studied.
Headed by researchers at Duke University Medical Center in Durham, N.C., the study enrolled 5,745 patients with STEMI at 296 locations in the United States, Canada, Australia, New Zealand and 13 European countries from July 2004 to May 2006.
Of those patients, there were 5,571 – 97 percent – included in the analysis who survived hospitalization and were discharged. These patients represent 17 different countries, and out of these patients, 631 – 11.3 percent – were readmitted within 30 days after being discharged from the hospital. Patients with multivessel disease from the United States were more like than patients from other countries to be readmitted within 30 days. Patients with multivessel disease had almost twice the odds of readmission compared to those without the condition, and U.S. heart attack patients had a 68 percent increased chance of readmission versus patients in other countries.
Being located in the United States was not a predictor of in-hospital death or 30-day postadmission death, according to the study.
Not only were readmission rates higher among U.S. patients, but median length of stay in the hospital was also shortest in the United States at three days. In Germany, the median length of stay, or LOS was longest, at eight days for patients with heart attack.
In the United States, the rates of readmission for elective revascularization after STEMI are higher than in other countries studied.
The authors write that median length of stay as well as early readmission for elective revascularization in the United States may contribute to a higher likelihood of 30-day readmission for U.S. patients.
“In particular, country-level median LOS attenuates the relationship between the United States and early readmission,” according to the researchers. “Further research is needed to better understand the relationship between LOS and readmission rates and define and optimize overall efficiency of care internationally.”
Although the study linked higher readmissions to the United States and suggests that readmissions may be avoidable, the authors point out that the study has limitations. First, they note that the study is a retrospective of clinical trial data and because the population was a selected clinical trial population, the results may not be comparable to the entire STEMI population. Another limitation of the study is that some countries surveyed enrolled relatively few patients in the study, limiting the ability to compare statistic between those countries and the United States.
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