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Multiple Blockages, U.S. Heart Attack Care Ups Readmissions

Shorter initial hospitalizations for heart attacks increase odds for readmission by 68 percent

TUESDAY, Jan. 3 (HealthDay News) -- Patients treated for heart attacks in the United States have shorter initial hospital stays but significantly higher rates of 30-day readmission compared with patients in other countries, according to a study published in the Jan. 4 issue of the Journal of the American Medical Association.

Robb D. Kociol, M.D., of the Duke University Medical Center in Durham, N.C., and colleagues retrospectively examined the admission and discharge data on 5,745 ST-segment elevation myocardial infarction (STEMI) patients from 17 countries enrolled in the Assessment of Pexelizumab in Acute Myocardial Infarction clinical trial.

The researchers found that 631 (11.3 percent) of the 5,571 patients who survived STEMI and were discharged were readmitted within 30 days, but the readmission rate varied geographically and the 30-day readmission rate was significantly higher in the United States compared with other countries (14.5 versus 9.9 percent). The United States had the shortest median initial length of stay (three days) and Germany had the longest (eight days). In a multivariable regression analysis, the greatest predictors of 30-day readmission were multivessel disease, which nearly doubled the risk of readmission (odds ratio (OR), 1.97), and receiving treatment in the United States (OR, 1.68). After adjusting for country-level median length of stay, treatment in the United States was no longer an independent predictor of 30-day readmission. Treatment in the United States was not a predictor of in-hospital or 30-day post-admission death.

"In this multinational study, there was variation across countries in 30-day readmission rates after STEMI, with readmission rates higher in the United States than in other countries. However, this difference was greatly attenuated after adjustment for length of stay," the authors write.

The Assessment of Pexelizumab in Acute Myocardial Infarction study was funded by the pharmaceutical industry.

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