Cargando…

Time-trends and predictors of interhospital transfers and 30-day rehospitalizations after acute coronary syndrome from 2000-2015

AIMS: Assess trends and factors associated with interhospital transfers (IHT) and 30-day acute coronary syndrome (ACS) rehospitalizations in a national administrative database of patients admitted with an ACS between 2000–2015. METHODS AND RESULTS: Cohort study of patients hospitalized with ACS from...

Descripción completa

Detalles Bibliográficos
Autores principales: Rocha, J. Afonso, Cardoso, José Carlos, Freitas, Alberto, Allison, Thomas G., Azevedo, Luís F.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8297861/
https://www.ncbi.nlm.nih.gov/pubmed/34293045
http://dx.doi.org/10.1371/journal.pone.0255134
_version_ 1783725943262543872
author Rocha, J. Afonso
Cardoso, José Carlos
Freitas, Alberto
Allison, Thomas G.
Azevedo, Luís F.
author_facet Rocha, J. Afonso
Cardoso, José Carlos
Freitas, Alberto
Allison, Thomas G.
Azevedo, Luís F.
author_sort Rocha, J. Afonso
collection PubMed
description AIMS: Assess trends and factors associated with interhospital transfers (IHT) and 30-day acute coronary syndrome (ACS) rehospitalizations in a national administrative database of patients admitted with an ACS between 2000–2015. METHODS AND RESULTS: Cohort study of patients hospitalized with ACS from 2000 to 2015, using a validated linkage algorithm to identify and link patient-level sequential hospitalizations occurring within 30 days from first admission (considering all hospitalizations within the 30-day timeframe as belonging to the same ACS episode of care-ACS-EC). From 212,481 ACS-EC, 42,670 (20.1%) had more than one hospitalization. ACS-EC hospitalization rates decreased throughout the study period (2000: 207.7/100.000 person-years to 2015: 185,8/100,000 person-years, p for trend <0.05). Proportion of IHT increased from 10.5% in 2000 to 20.1% in 2015 compared to a reduction in both planned and unplanned 30-day ACS rehospitalization from 9.0% in 2000 to 2.7% in 2015. After adjusting for patient and first admission hospital’s characteristics, compared to 2000–2003, in 2012–2015 the odds of IHT increased by 3.81 (95%CI: 3.65–3.98); the odds of unplanned and planned 30-day ACS rehospitalization decreased by 0.36 (95%CI: 0.33; 0.39) and 0.47 (95%CI: 0.43; 0.53), respectively. Female sex, older age and the presence and severity of comorbidities were associated with lower likelihood of being transferred or having a planned 30-day ACS rehospitalization. Unplanned 30-day ACS rehospitalization was more likely in patients with higher comorbidity burden. CONCLUSION: IHT and 30-day ACS rehospitalization reflect coronary referral network efficiency and access to specialized treatment. Identifying factors associated with higher likelihood of IHT and 30-day ACS rehospitalization may allow heightened surveillance and interventions to reduce rehospitalizations and inequities in access to specialized treatment.
format Online
Article
Text
id pubmed-8297861
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-82978612021-07-31 Time-trends and predictors of interhospital transfers and 30-day rehospitalizations after acute coronary syndrome from 2000-2015 Rocha, J. Afonso Cardoso, José Carlos Freitas, Alberto Allison, Thomas G. Azevedo, Luís F. PLoS One Research Article AIMS: Assess trends and factors associated with interhospital transfers (IHT) and 30-day acute coronary syndrome (ACS) rehospitalizations in a national administrative database of patients admitted with an ACS between 2000–2015. METHODS AND RESULTS: Cohort study of patients hospitalized with ACS from 2000 to 2015, using a validated linkage algorithm to identify and link patient-level sequential hospitalizations occurring within 30 days from first admission (considering all hospitalizations within the 30-day timeframe as belonging to the same ACS episode of care-ACS-EC). From 212,481 ACS-EC, 42,670 (20.1%) had more than one hospitalization. ACS-EC hospitalization rates decreased throughout the study period (2000: 207.7/100.000 person-years to 2015: 185,8/100,000 person-years, p for trend <0.05). Proportion of IHT increased from 10.5% in 2000 to 20.1% in 2015 compared to a reduction in both planned and unplanned 30-day ACS rehospitalization from 9.0% in 2000 to 2.7% in 2015. After adjusting for patient and first admission hospital’s characteristics, compared to 2000–2003, in 2012–2015 the odds of IHT increased by 3.81 (95%CI: 3.65–3.98); the odds of unplanned and planned 30-day ACS rehospitalization decreased by 0.36 (95%CI: 0.33; 0.39) and 0.47 (95%CI: 0.43; 0.53), respectively. Female sex, older age and the presence and severity of comorbidities were associated with lower likelihood of being transferred or having a planned 30-day ACS rehospitalization. Unplanned 30-day ACS rehospitalization was more likely in patients with higher comorbidity burden. CONCLUSION: IHT and 30-day ACS rehospitalization reflect coronary referral network efficiency and access to specialized treatment. Identifying factors associated with higher likelihood of IHT and 30-day ACS rehospitalization may allow heightened surveillance and interventions to reduce rehospitalizations and inequities in access to specialized treatment. Public Library of Science 2021-07-22 /pmc/articles/PMC8297861/ /pubmed/34293045 http://dx.doi.org/10.1371/journal.pone.0255134 Text en © 2021 Rocha et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Rocha, J. Afonso
Cardoso, José Carlos
Freitas, Alberto
Allison, Thomas G.
Azevedo, Luís F.
Time-trends and predictors of interhospital transfers and 30-day rehospitalizations after acute coronary syndrome from 2000-2015
title Time-trends and predictors of interhospital transfers and 30-day rehospitalizations after acute coronary syndrome from 2000-2015
title_full Time-trends and predictors of interhospital transfers and 30-day rehospitalizations after acute coronary syndrome from 2000-2015
title_fullStr Time-trends and predictors of interhospital transfers and 30-day rehospitalizations after acute coronary syndrome from 2000-2015
title_full_unstemmed Time-trends and predictors of interhospital transfers and 30-day rehospitalizations after acute coronary syndrome from 2000-2015
title_short Time-trends and predictors of interhospital transfers and 30-day rehospitalizations after acute coronary syndrome from 2000-2015
title_sort time-trends and predictors of interhospital transfers and 30-day rehospitalizations after acute coronary syndrome from 2000-2015
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8297861/
https://www.ncbi.nlm.nih.gov/pubmed/34293045
http://dx.doi.org/10.1371/journal.pone.0255134
work_keys_str_mv AT rochajafonso timetrendsandpredictorsofinterhospitaltransfersand30dayrehospitalizationsafteracutecoronarysyndromefrom20002015
AT cardosojosecarlos timetrendsandpredictorsofinterhospitaltransfersand30dayrehospitalizationsafteracutecoronarysyndromefrom20002015
AT freitasalberto timetrendsandpredictorsofinterhospitaltransfersand30dayrehospitalizationsafteracutecoronarysyndromefrom20002015
AT allisonthomasg timetrendsandpredictorsofinterhospitaltransfersand30dayrehospitalizationsafteracutecoronarysyndromefrom20002015
AT azevedoluisf timetrendsandpredictorsofinterhospitaltransfersand30dayrehospitalizationsafteracutecoronarysyndromefrom20002015