ArticleJournal of the American Heart Association2018
Clinical Profile of Acute Myocardial Infarction Patients Included in the Hospital Readmissions Reduction Program.
Article in Journal of the American Heart Association, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- Readmission After ACS: Burden, Epidemiology, and Mitigation.Current cardiology reports · 2022Review
- Acute Myocardial Infarction Cohorts Defined byCirculation. Cardiovascular quality and outcomes · 2021Article
- Myocardial Infarction Type 2: Avoiding Pitfalls and Preventing Adverse Outcomes.Clinical medicine & research · 2020Article
- Myocardial infarction classification and its implications on measures of cardiovascular outcomes, quality, and racial/ethnic disparities.Clinical cardiology · 2020Review
- Association of an Acute Myocardial Infarction Readmission-Reduction Program With Mortality and Readmission.Circulation. Cardiovascular quality and outcomes · 2020Article
- Understanding Readmissions in Medicare Beneficiaries During the 90-Day Follow-Up Period of an Acute Myocardial Infarction Admission.Journal of the American Heart Association · 2019Article
- Misclassification of Myocardial Injury as Myocardial Infarction: Implications for Assessing Outcomes in Value-Based Programs.JAMA cardiology · 2019Observational
- Clinical Profile of Acute Myocardial Infarction Patients Included in the Hospital Readmissions Reduction Program.Journal of the American Heart Association · 2018Article
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Authors and funding
7 authors.
Funding
Abstract
Background Medicare's Hospital Readmissions Reduction Program assesses financial penalties to hospitals based on risk-standardized readmission rates after specific episodes of care, including acute myocardial infarction. Detailed information about the type of patients included in the penalty is unknown. Methods and Results Starting with administrative data from Medicare, we conducted physician-adjudicated chart reviews of all patients considered 30-day readmissions after acute myocardial infarction from July 2012 to June 2015. Of 197 readmissions, 68 (34.5%) received percutaneous coronary intervention and 18 (9.1%) underwent coronary artery bypass grafting on index hospitalization. The remaining 111 patients did not receive any intervention. Of the 197 patients, 56 patients (28.4%) were considered too high risk for invasive management, 23 (11.7%) had nonobstructive coronary artery disease on diagnostic catheterization and therefore no indication for revascularization, 19 patients had a type II myocardial infarction (9.6%) for which noninvasive, outpatient workup was recommended, and 13 (6.6%) declined further care. The most common readmission diagnoses were cardiac causes and noncardiac chest discomfort, infection, and gastrointestinal bleeding. Conclusions Our results demonstrate that more than a quarter of the patients included in the penalty do not receive revascularization either because of provider assessment of risk or patient preference, and nearly one tenth have type II myocardial infarction. As such, administrative codes for prohibitive procedural risk, patient-initiated "do not resuscitate" status, or type II myocardial infarction may improve the risk-adjustment of the metric. Furthermore, provider organizations seeking to reduce readmission rates should focus resources on the needs of these patients, such as care coordination, hospice services when requested by patients, and treatment of noncardiac conditions.
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