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Trends and predictors of rehospitalisation following an acute coronary syndrome: report from the Australian and New Zealand population of the Global Registry of Acute Coronary Events (GRACE)
Authors
Sangu, Prashanthi V.Ranasinghe, Isuru
Aliprandi-Costa, Bernadette
Devlin, Gerard
Elliot, John
Lefkovits, Jeffrey
Brieger, David
UMass Chan Affiliations
Center for Outcomes ResearchDocument Type
Journal ArticlePublication Date
2012-12-01Keywords
Acute Coronary SyndromeAged
Female
Follow-Up Studies
Humans
Incidence
Male
*Myocardial Revascularization
New South Wales
New Zealand
Patient Readmission
Prognosis
*Registries
Retrospective Studies
Risk Assessment
Risk Factors
Cardiology
Cardiovascular Diseases
Health Services Research
Metadata
Show full item recordAbstract
BACKGROUND: Readmission following an acute coronary syndrome (ACS) is frequent in our community. Patient specific factors identifying those at risk of readmission are poorly described. METHODS: Data were analysed from 5219 patients with an ACS enrolled in the Australian and New Zealand population of the Global Registry of Acute Coronary Events (GRACE) between 1999 and 2007. Patients who were readmitted for cardiovascular disease within 6 months of discharge were identified; regression analysis was used to predict independent patient factors associated with readmission 1 month and 1-6 months after discharge. RESULTS: 1048 patients (20.1%) were readmitted within 6 months, with a significant proportion (n=434, 41.4%) of readmissions occurring within 30 days of discharge. Readmission within 6 months was associated with a higher incidence of unscheduled cardiac catheterisation (HR 25.64, 95% CI 18.41 to 35.71), unscheduled percutaneous coronary intervention (PCI) (HR 15.78, 95% CI 10.56 to 23.59), stroke (HR 1.92, 95% CI 1.08 to 3.43), and death (HR 2.40, 95% CI 1.66 to 3.49). Recurrent ischemia in hospital and a diagnosis of S-T elevation myocardial infarction during the index admission were associated with the strongest risk of early rehospitalisation, while revascularisation by PCI or coronary artery bypass surgery (CABG) was associated with lowest risk of early readmission. A history of heart failure, prior myocardial infarction or angina was associated with a greater likelihood of later rehospitalisation, whereas revascularisation by CABG was associated with the lowest risk of later rehospitalisation. CONCLUSIONS: Several patient and clinical factors identify patients at higher risk of readmission. Identifying these factors and escalating in-hospital and post-discharge care for these higher risk patients may prevent readmission and improve outcome.Source
Sangu PV, Ranasinghe I, Aliprandi Costa B, Devlin G, Elliot J, Lefkovitz J, Brieger D. Trends and predictors of rehospitalisation following an acute coronary syndrome: report from the Australian and New Zealand population of the Global Registry of Acute Coronary Events (GRACE). Heart. 2012 Dec;98(23):1728-31. doi:10.1136/heartjnl-2012-302532. Link to article on publisher's siteDOI
10.1136/heartjnl-2012-302532Permanent Link to this Item
http://hdl.handle.net/20.500.14038/27184PubMed ID
23010286Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1136/heartjnl-2012-302532