Fallout From Rehospitalization After Acute MI May Extend Beyond Economics

Beyond their economic implications, readmissions for unplanned revascularization and unstable angina in patients who have previously been hospitalized for acute MI seem to have detrimental effects on patient health status down the line, according to observational data.

Paying attention to this type of data may no longer be optional in an era when patients are living longer post-MI. “Now we're going to have a responsibility to measure what happens to people as they get back into their normal life routines and what’s the economic impact of getting back into their normal life routines,” Joseph G. Cacchione, MD (Cleveland Clinic Foundation, OH), who was not involved with the research, told TCTMD.

For the study, published online this week in Circulation: Cardiovascular Quality and Outcomes, Supriya Shore, MD, MSCS (Emory University School of Medicine, Atlanta, GA), and colleagues looked at validated health status measures—scores from the Seattle Angina Questionnaire (SAQ) and EuroQol-5D Visual Analog Scale (EQ-5D VAS)—from 3,283 patients with acute MI enrolled in the TRIUMPH registry between 2005 and 2008.

In propensity-matched analyses of patients who were and were not hospitalized for unstable angina or unplanned coronary revascularization within a year following their index hospitalization, rehospitalization was associated with poorer outcomes, even after adjustment.

The findings suggest that these rehospitalizations “have a sustained and clinically meaningful impact on patients beyond the transient inconvenience they cause,” the authors write.

Moving forward, “we should be starting to focus on quality of life measures beyond what we have traditionally measured—functional status measures, return to work, all of those things,” Cacchione said. “There are outcomes beyond . . . just a hospital stay as we start to get into different payment methods of longitudinal episode-based payments where you're being paid for the whole year of somebody's care, or even at a more global level if you are going to start to measure the effect on a population.”

Shore and colleagues agree, writing that while rehospitalizations may be a valid endpoint for some clinical trials, future research should “better define whether close monitoring of patients’ health status might identify those at risk for readmission, who therefore could be targeted for more aggressive treatment strategies to prevent rehospitalizations while also preserving or improving health status.”

Examples of these could include “adding a behavioral health play [interventions], counseling or treatment for depression, or more aggressive care coordination,” Cacchione concluded. “There’s a whole host of things you can do to try and manage these problems.”

Sources
  • Shore S, Smolderen KG, Kennedy KF, et al. Health outcomes in patients with acute myocardial infarction after rehospitalization. Circ Cardiovasc Qual Outcomes. 2016;Epub ahead of print.

Disclosures
  • The study was funded through a research grant from Eli Lilly.
  • Shore and Cacchione report no relevant conflicts of interest.

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