The following is the summary of “Care Fragmentation After Hospitalization for Acute Myocardial Infarction” published in the January 2023 issue of Cardiovascular Disease by Sakowitz, et al.

Poor clinical and economic outcomes have been associated with care fragmentation (CF), often known as readmission to a non-index institution. Acute myocardial infarction (AMI) sufferers are uncertain about its effects. The incidence of CF and its effect on AMI patient outcomes were examined in this study. Using the National Readmissions Database, we identified all hospitalizations for AMI in adult patients in the United States (≥18 years old) from January 2010 to November 2019.

Patients were divided into 2 groups, index, and non-index readmissions. Independent correlations between mortality, complications, and resource use were assessed using multivariable models created to examine risk variables for CF. Patients with acute myocardial infarction who were readmitted for any reason within 30 days of their initial discharge number 413,819. About 25% (n=104,966) of these people had CF. From 2010 to 2019, the occurrence of CF rose (nptrend <0.001). As a result of the change, Medicaid patients were more likely to be readmitted for reasons other than the index hospitalization. Hospitalization mortality was higher among people with CF (adjusted odds ratio [AOR] 1.09, 95% CI 1.01 to 1.18), cardiac (AOR1.12; 95%  CI, 1.03 to 1.22); respiratory (AOR1.14; 95%  CI, 1.12 to 1.26); and infectious (AOR1.14; 95% CI, 1.07 to 1.22) problems were all higher among people with CF.

In addition, CF was associated with a ∼$5,000 increase in per-patient hospitalization expenses (95% CI 4,260 to 5,100) and an increased likelihood of non-home discharge (AOR 1.18, 95% CI 1.11 to 1.24). About 25% of people who had an AMI also had CF, which was linked to higher rates of death, more serious sequelae, and higher medical bills. Non-Index readmissions have major clinical and financial repercussions that must be mitigated to improve value-based healthcare and address the growing national burden of cardiovascular disease.

Source: sciencedirect.com/science/article/pii/S0002914922011705