Re-admission rates high among U.S. heart attack patients: Study

By Dr. Ananya Mandal, MDJan 4 2012

According to new research from U.S health experts, Americans who have a severe form of a heart attack are far more likely to be readmitted to the hospital than people from 16 other countries with the same kind of heart attack.

The results of the study showed that overall, heart attack sufferers from the United States were 68 percent more likely to be readmitted within one month of their discharge than patients in other countries. The findings appeared in the Journal of the American Medical Association.

The study involved 5,745 patients from the United States, Canada, Australia, New Zealand and 13 European countries. All had a type of heart attack called an ST-segment elevation myocardial infarction or STEMI, in which the coronary artery is completely blocked. It found the two most common factors involving being readmitted to the hospital were having blockages in more than one artery and being treated in the United States.

According to Duke University cardiologist Dr. Robb D. Kociol and his team, 60 percent of U.S. patients were discharged in three days or less, but 14.5 percent of them returned to the hospital within a month. Among patients from other countries, more than half (54 percent) stayed in the hospital for at least six days, and only 9.9 percent of these patients needed to be readmitted to the hospital within a month. The longest stay among the countries was eight days, in Germany.

“One of the unique things about the United States was that the length of stay was shorter,” Dr. Manesh Patel of Duke University in North Carolina, who worked on the study, said in a telephone interview. “We're not saying that you have to stay in the hospital longer in the United States,” he said. Instead, he said the length of a person's hospital stay is likely a marker of the kind of care you are getting in the United States versus the rest of the world. “We are very good at in getting you in and getting your artery open. And we can get you home pretty quickly, which I think is still safe,” he said. “It's not clear we do as good a job as the rest of the world in getting patients from the hospital to home,” he said, referring to efforts to ensure that patients have a primary care doctor and know who to call if they have any problems.

The U.S. Centers for Medicare & Medicaid Services has begun using 30-day hospital readmission rates as a measure of treatment quality, and Patel said the findings may offer some insight about how much are heart patients need before they are released from the hospital. “We don't know if simply making the stay longer would help - we don't know that at all,” Patel said in a statement. “We just know that when the stay is shorter, the correlation is associated with more readmissions,” he said.

“Significant attention has been focused on reducing acute myocardial infection readmission rates in the United States as a means of reducing health-care costs, according to the assumption that readmission is, at least in part, preventable,” the authors wrote. “Our analysis shows that readmission may be preventable because rates are nearly one-third lower in other countries suggesting the U.S. health care system has features that can be modified to decrease readmission rates.” More study is needed to better understand the relationship between length of stay and readmission rates, the researchers said.

The study’s limitations include that it was a retrospective analysis of data from a clinical trial, they said. The original trial evaluated pexelizumab, an experimental cardiology compound that is now being studied by Cheshire, Connecticut-based Alexion Pharmaceuticals Inc.

In the U.S., each year 785,000 people have a first heart attack, and 470,000 who’ve already had one have another, according to the U.S. Centers for Disease Control and Prevention in Atlanta.