Hospital readmission rates within 30 days after ST-segment elevation myocardial infarction (STEMI) have been proposed as a metric for the quality of care. Kociol and colleagues performed a post hoc analysis of data from a large multinational trial that enrolled 5,745 patients at 296 sites in 17 countries to determine variations in and predictors of 30-day readmission after STEMI.

Of 5,571 patients who survived to hospital discharge, 631 (11.3%) were readmitted within 30 days. The 30-day readmission rate was significantly higher in the United States than in other countries (14.5% versus 9.9%). Rates of in-hospital death and death by 30 days after admission weren't significantly different between U.S. patients and patients in the other countries, but 60% of U.S. STEMI patients had a hospital stay of three days or less, compared with 15.9% of patients in other countries.

On multivariable analysis, multivessel disease, trial enrollment in the United States, and baseline heart rate were the strongest predictors of 30-day all-cause readmission. The odds of 30-day readmission were 68% higher among U.S. patients, compared with those in other countries. After exclusion of elective readmission for revascularization, U.S. enrollment remained an independent predictor of readmission.

Hospital stays after STEMI are longer in other countries than in the United States, where they have diminished dramatically in recent years. After adjustment for country-level length of stay, U.S. enrollment was no longer significantly associated with 30-day readmission.

The inverse relationship between length of stay and readmission rates suggests that higher readmission rates may be an adverse consequence of shorter hospital stays after STEMI in the United States, the authors write, and they call for further research on the economic trade-off between prolonging index hospital stays and reducing readmissions.-KR

Reference