International variation in and factors associated with hospital readmission after myocardial infarction.
BACKGROUND
ST-segment elevation myocardial infarction (STEMI) treatment has improved outcomes and shortened hospital stay. Recently, 30-day readmission rates have been proposed as a metric for care of patients with STEMI. However, international rates and predictors of 30-day readmission after STEMI have not been studied.


OBJECTIVE
To determine international variation in and predictors of 30-day readmission rates after STEMI and country-level care patterns.


METHODS
Post hoc analysis of the Assessment of Pexelizumab in Acute Myocardial Infarction trial that enrolled 5745 patients with STEMI at 296 sites in the United States, Canada, Australia, New Zealand, and 13 European countries from July 13, 2004, to May 11, 2006. Multivariable logistic regression analysis was used to identify independent predictors of all-cause and nonelective 30-day postdischarge readmission.


METHODS
Predictors of 30-day postdischarge all-cause and nonelective readmissions.


RESULTS
Of 5571 patients with STEMI who survived to hospital discharge, 631 (11.3%) were readmitted within 30 days. Thirty-day readmission rates were higher for the United States than other countries (14.5% vs 9.9%; P < .001). Median length of stay was shortest for US patients (3 days; interquartile range, 2-4 days) and longest for Germany (8 days; interquartile range, 6-11 days). In multivariable regression, the predictors of 30-day readmission included multivessel disease (odds ratio [OR], 1.97; 95% CI, 1.65-2.35) and US location (OR, 1.68; 95% CI, 1.37-2.07). Excluding elective readmission for revascularization, US enrollment was still an independent predictor of readmission (OR, 1.53; 95% CI, 1.20-1.96). After adjustment of the models for country-level median length of stay, US location was no longer an independent predictor of 30-day all-cause or nonelective readmission. Location in the United States was not a predictor of in-hospital death (OR, 0.88; 95% CI, 0.60-1.30) or 30-day postadmission death (OR, 1.0; 95% CI, 0.72-1.39).


CONCLUSIONS
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.
Duke Clinical Research Institute, Duke University Medical Center, PO Box 17969, Durham, NC 27715, USA.
Robb D
RD
Kociol
Renato D
RD
Lopes
Robert
R
Clare
Laine
L
Thomas
Rajendra H
RH
Mehta
Padma
P
Kaul
Karen S
KS
Pieper
Judith S
JS
Hochman
W Douglas
WD
Weaver
Paul W
PW
Armstrong
Christopher B
CB
Granger
Manesh R
MR
Patel
D000368:Aged; D001315:Australia / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D005544:Forecasting; D017052:Hospital Mortality; D006801:Humans; D038622:Internationality; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D009520:New Zealand / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D014481:United States / Q000453:epidemiology