Cargando…

Thirty-day rehospitalizations among elderly patients with acute myocardial infarction: Impact of postdischarge ambulatory care

Rehospitalization after acute myocardial infarction (AMI) is common in elderly patients. It increases morbimortality and health care expenditures. The association between ambulatory care after discharge for AMI and rehospitalization has never been studied in France. We analyzed the impact of ambulat...

Descripción completa

Detalles Bibliográficos
Autores principales: Zabawa, Claire, Cottenet, Jonathan, Zeller, Marianne, Mercier, Grégoire, Rodwin, Victor G., Cottin, Yves, Quantin, Catherine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6023939/
https://www.ncbi.nlm.nih.gov/pubmed/29901621
http://dx.doi.org/10.1097/MD.0000000000011085
_version_ 1783335957755330560
author Zabawa, Claire
Cottenet, Jonathan
Zeller, Marianne
Mercier, Grégoire
Rodwin, Victor G.
Cottin, Yves
Quantin, Catherine
author_facet Zabawa, Claire
Cottenet, Jonathan
Zeller, Marianne
Mercier, Grégoire
Rodwin, Victor G.
Cottin, Yves
Quantin, Catherine
author_sort Zabawa, Claire
collection PubMed
description Rehospitalization after acute myocardial infarction (AMI) is common in elderly patients. It increases morbimortality and health care expenditures. The association between ambulatory care after discharge for AMI and rehospitalization has never been studied in France. We analyzed the impact of ambulatory care on rehospitalization of elderly patients (≥65 years) within 30 days after hospital discharge. We conducted a nationwide population-based study of elderly patients hospitalized with a main diagnosis of AMI in France between 2011 and 2013. We excluded patients hospitalized for AMI in the previous year and those who died during the index hospitalization or within 30 days after discharge. The primary outcome was the first all-cause 30-day rehospitalization in an acute care hospital. Individual and neighborhood-level variables were compared among rehospitalized and nonrehospitalized patients. Determinants of 30-day rehospitalization were identified using logistic regression models. Among the 624 eligible patients, 137 (22.0%) were rehospitalized within 30 days after discharge. In multivariate analyses, chronic kidney failure (odds ratio [OR] 1.88; 95% confidence interval [CI], 1.01–3.53) was an independent predictor of 30-day rehospitalization. We found no association among deprivation and spatial accessibility measures and 30-day rehospitalization. The purchase of lipid-lowering drugs prescription within 7 days after discharge was associated with a reduced risk of 30-day rehospitalization (OR 0.53; 95% CI, 0.36–0.79). This study highlights the role of coordination among hospital and primary care physicians in post-AMI discharge and follow-up among elderly patients. Specifically, targeted interventions to reduce 30-day rehospitalizations should focus on patients with comorbidities and use of prescription drugs after hospital discharge.
format Online
Article
Text
id pubmed-6023939
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Wolters Kluwer Health
record_format MEDLINE/PubMed
spelling pubmed-60239392018-07-03 Thirty-day rehospitalizations among elderly patients with acute myocardial infarction: Impact of postdischarge ambulatory care Zabawa, Claire Cottenet, Jonathan Zeller, Marianne Mercier, Grégoire Rodwin, Victor G. Cottin, Yves Quantin, Catherine Medicine (Baltimore) Research Article Rehospitalization after acute myocardial infarction (AMI) is common in elderly patients. It increases morbimortality and health care expenditures. The association between ambulatory care after discharge for AMI and rehospitalization has never been studied in France. We analyzed the impact of ambulatory care on rehospitalization of elderly patients (≥65 years) within 30 days after hospital discharge. We conducted a nationwide population-based study of elderly patients hospitalized with a main diagnosis of AMI in France between 2011 and 2013. We excluded patients hospitalized for AMI in the previous year and those who died during the index hospitalization or within 30 days after discharge. The primary outcome was the first all-cause 30-day rehospitalization in an acute care hospital. Individual and neighborhood-level variables were compared among rehospitalized and nonrehospitalized patients. Determinants of 30-day rehospitalization were identified using logistic regression models. Among the 624 eligible patients, 137 (22.0%) were rehospitalized within 30 days after discharge. In multivariate analyses, chronic kidney failure (odds ratio [OR] 1.88; 95% confidence interval [CI], 1.01–3.53) was an independent predictor of 30-day rehospitalization. We found no association among deprivation and spatial accessibility measures and 30-day rehospitalization. The purchase of lipid-lowering drugs prescription within 7 days after discharge was associated with a reduced risk of 30-day rehospitalization (OR 0.53; 95% CI, 0.36–0.79). This study highlights the role of coordination among hospital and primary care physicians in post-AMI discharge and follow-up among elderly patients. Specifically, targeted interventions to reduce 30-day rehospitalizations should focus on patients with comorbidities and use of prescription drugs after hospital discharge. Wolters Kluwer Health 2018-06-15 /pmc/articles/PMC6023939/ /pubmed/29901621 http://dx.doi.org/10.1097/MD.0000000000011085 Text en Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle Research Article
Zabawa, Claire
Cottenet, Jonathan
Zeller, Marianne
Mercier, Grégoire
Rodwin, Victor G.
Cottin, Yves
Quantin, Catherine
Thirty-day rehospitalizations among elderly patients with acute myocardial infarction: Impact of postdischarge ambulatory care
title Thirty-day rehospitalizations among elderly patients with acute myocardial infarction: Impact of postdischarge ambulatory care
title_full Thirty-day rehospitalizations among elderly patients with acute myocardial infarction: Impact of postdischarge ambulatory care
title_fullStr Thirty-day rehospitalizations among elderly patients with acute myocardial infarction: Impact of postdischarge ambulatory care
title_full_unstemmed Thirty-day rehospitalizations among elderly patients with acute myocardial infarction: Impact of postdischarge ambulatory care
title_short Thirty-day rehospitalizations among elderly patients with acute myocardial infarction: Impact of postdischarge ambulatory care
title_sort thirty-day rehospitalizations among elderly patients with acute myocardial infarction: impact of postdischarge ambulatory care
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6023939/
https://www.ncbi.nlm.nih.gov/pubmed/29901621
http://dx.doi.org/10.1097/MD.0000000000011085
work_keys_str_mv AT zabawaclaire thirtydayrehospitalizationsamongelderlypatientswithacutemyocardialinfarctionimpactofpostdischargeambulatorycare
AT cottenetjonathan thirtydayrehospitalizationsamongelderlypatientswithacutemyocardialinfarctionimpactofpostdischargeambulatorycare
AT zellermarianne thirtydayrehospitalizationsamongelderlypatientswithacutemyocardialinfarctionimpactofpostdischargeambulatorycare
AT merciergregoire thirtydayrehospitalizationsamongelderlypatientswithacutemyocardialinfarctionimpactofpostdischargeambulatorycare
AT rodwinvictorg thirtydayrehospitalizationsamongelderlypatientswithacutemyocardialinfarctionimpactofpostdischargeambulatorycare
AT cottinyves thirtydayrehospitalizationsamongelderlypatientswithacutemyocardialinfarctionimpactofpostdischargeambulatorycare
AT quantincatherine thirtydayrehospitalizationsamongelderlypatientswithacutemyocardialinfarctionimpactofpostdischargeambulatorycare