Post-MI angina linked to increased late readmission risk

By Laura Cowen

US researchers are calling for greater surveillance and treatment of post-myocardial infarction (MI) angina after their findings show an increased risk of late readmission among patients with angina symptoms at 30 days.

"Patients with angina at 30 days are a high-risk group who may benefit from targeted clinical interventions during routine clinical follow-up to avoid late readmissions", say Jacob Doll (Duke University, Durham, North Carolina) and colleagues.

They used the Seattle Angina Questionnaire to assess the change in angina status pre- and post-MI in 2915 patients enrolled at 24 hospitals in the Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status (TRIUMPH) registry.

Overall, 1278 (43.8%) patients were angina-free both 4 weeks before and 30 days after their MI, 788 (27.1%) had angina before admission that resolved by 30 days, 344 (11.8%) had new angina develop after their MI and 505 (17.3%) reported angina both before and after MI.

At 1 year, the overall readmission rates for patients with persistent or newly developed angina were around 35%, which was significantly higher than the 23-25% observed for patients with no post-MI angina.

Similarly, there was a significantly higher rate of readmission for MI or unplanned (nonelective) revascularisation among patients with persistent or new angina compared with those with no angina at 30 days.

After adjustment for potential confounders, the researchers showed that patients with persistent angina had a 35% increased risk of 1-year all-cause readmission, while the risk was 40% higher for those with new angina, when compared with patients who were angina-free pre-and post-MI.

The researchers also looked at angina prevalence at 1 year, which was 22% overall. However, the risk of having angina at this time was a significant 3.55-fold higher for patients with persistent angina and 3.38-fold higher for those with new angina, compared with patients who had no angina pre- or post-MI. The risk was also a significant 1.61-fold higher for patients with resolved angina.

Doll and team say their findings highlight "the important association of angina symptoms with admissions after 30 days", which is the typical cutoff used by the Hospital Readmissions Reduction Program of the Affordable Care Act as a measure of hospital quality.

They conclude in the Journal of the American Heart Association: "Future research to examine novel strategies to reduce post-MI angina should be undertaken in an effort to reduce readmission rates and improve long-term angina control in this high-risk population."

Source: J Am Heart Assoc 2016; Advance online publication

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