Two factors strongly increase the chance that heart attack patients will end up right back in the hospital after they are released. One is having multiple blocked arteries. The other is living in the United States, Duke University researchers reported on Tuesday.
“This was a bit of a shocking finding for us,” said Dr. Manesh Patel, who led the study.
The study, published in the Journal of the American Medical Association, found a link between short hospital stays and high readmission rates in the United States.
Hospital readmission rates within a 30-day window are becoming a popular quality measure, Patel noted. As health care reform moves forward in the U.S., the new study could help policymakers dig into how to best reduce costly hospital stays and improve care quality overall.
In general, reducing hospital readmissions is a good idea, Patel said in a telephone interview. "You want to do a more efficient job of caring for patients upfront," he said.
The study team analyzed data from a clinical trial performed between 2004 and 2006, involving more than 5,500 heart attack patients living in the U.S., Canada, Australia, New Zealand, and several European countries. Patients had suffered a certain kind of heart attack, known as a STEMI, in which a patient's artery becomes totally blocked by a blood clot. Most patients enrolled in the trial were male, and their average age was 61.
The study found three factors upped a patient's chance of readmission. “Patients with multivessel disease had almost twice the odds of readmission compared to those without,” the researchers wrote. "Patients in the United States had 68 percent increased odds of readmission vs. those outside the United States.” An elevated heart rate increased a patient’s chances of having to return to the hospital by 9 percent.
More than 14 percent of U.S. patients enrolled in the trial were readmitted to the hospital within 30 days of going home, the study found. In other Western countries, fewer than 10 percent of patients—on average—needed to return to the hospital within a month.
When researchers adjusted the data to account for patients with multiple blocked arteries, living in the United States became less of a predictor for readmission-- perhaps because it's more common for patients in the U.S. to have bypass surgery, Patel suggested.
Further analysis indicated other differences in U.S. patients. “In the U.S., the average length of stay was about three days, whereas around the world it was six to eight days,” Patel said.
“By no means do we know that extending the length of stay reduces readmission,” Patel said. Rather, he said, the findings provide “a lesson in care coordination.”
Patients should be kept under observation for at least 48 hours after a severe heart attack, Patel said. Sending patients home after three days isn’t, in and of itself, a bad idea. The problems start when patients don’t get the follow-up care they need, or when information is lost as patients are passed from one physician to another.
“We’re going to have to look at problems like readmission from multiple angles,” Patel said.
The data did not reveal why patients were readmitted or the length of their second hospital stay, Patel said. The study also notes that Americans don't have higher death rates, either while in hospital or for the month afterward.
"One of the limitations with our study is there are probably other cultural differences in terms of health insurance coverage or primary care providers that we don't capture here," another of the researchers, Robb Kociol, said in a statement. "If anything, this suggests we need to look more at the differences internationally to optimize outcomes."