Association of Early Physician Follow-Up and 30-Day Readmission After Non–ST-Segment-Elevation Myocardial Infarction Among Older Patients
What is the relationship between early physician follow-up after admission for non–ST-segment elevation myocardial infarction (NSTEMI) and patient outcomes?
This was a post-hoc analysis of the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines (CRUSADE) Registry linked with longitudinal Medicare data. The authors included 25,872 NSTEMI patients ≥65 years of age discharged home from 228 hospitals. Early follow-up was defined as any physician outpatient visit within 7 days of discharge from the index hospitalization. Rates of early follow-up were calculated and reported at the hospital level for the overall study population, as well as by quartiles of hospital early follow-up. The primary outcome was all-cause readmission within 30 days after discharge from index hospitalization.
The median hospital-level percentage of patients receiving early physician follow-up was 23.3%, and 18.51% of patients were readmitted within 30 days of discharge from the index hospitalization. After adjustment for patient demographic and clinical characteristics, hospital features, and treatment features, adjusted rates of 30-day readmission did not differ among quartiles of hospital-level early physician follow-up.
The authors concluded that hospitals with higher early physician follow-up rates following discharge after NSTEMI did not have lower 30-day readmission rates.
Although it has been established that there is an association between physician follow-up within 7 days of discharge and reduced 30-day readmission in the heart failure population, the current analysis provides little evidence to schedule follow-up specifically within 1 week of discharge from an index hospitalization for NSTEMI. Nonetheless, readmissions following acute MI are common, and nearly one in five patients in this analysis of older patients was readmitted within 30 days of discharge. These findings suggest the need to explore alternative strategies to reduce the burden of readmissions after acute MI.
Keywords: Physicians, Myocardial Infarction, Follow-Up Studies, Cardiovascular Diseases, Electrocardiography, Medicare, United States
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