title: Health Status Outcomes in Patients With Acute Myocardial Infarction After Rehospitalization.
abstract: Rehospitalizations after acute myocardial infarction for unplanned coronary revascularization and unstable angina (UA) are common. However, despite the inclusion of these events in composite end points of many clinical trials, their association with health status has not been studied.
  
  
  
  We included 3283 patients with acute myocardial infarction enrolled in a prospective, 24-center US study who had rehospitalizations independently classified by experienced cardiologists. Health status was assessed using Seattle Angina Questionnaire and EuroQol-5D Visual Analog Scale. In the propensity-matched cohorts, 1-year health status was compared between those who did and did not experience rehospitalization for UA or revascularization using a hierarchical linear model. Overall, mean age was 59 years, 33% were women, and 70% were white. Rehospitalization rates for UA and unplanned revascularization at 1 year were 4.3% and 4.7%. One-year Seattle Angina Questionnaire summary scores were worse in patients with rehospitalizations for UA (mean difference, -10.1; 95% confidence interval, -12.4 to -7.9) and unplanned revascularization (mean difference, -5.7; 95% confidence interval, -8.8 to -2.5) when compared with patients without such rehospitalizations. Similarly, EuroQol-5D Visual Analog Scale scores were worse among patients with such readmissions. Individual Seattle Angina Questionnaire domains indicated worse 1-year angina and quality of life outcomes among patients rehospitalized for UA or unplanned revascularization.
  
  
  
  Within the first year after acute myocardial infarction, rehospitalizations for UA and unplanned revascularization are associated with worse health status. These findings highlight the impact of such events from a patient's perspective, beyond their economic impact and support the use of UA and unplanned revascularization as elements of composite end points.
authors: From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (S.S.); Department of Public Health, Faculty of Medicine & Health Sciences, Ghent University, Belgium (K.G.S.); Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.F.K., P.G.J., S.V.A., D.J.C., J.A.S.); University of Missouri Kansas City, Kansas City (K.G.S., S.V.A., D.J.C., J.A.S.); Division of Cardiology, Saint Louis University, MO (J.M.S.); Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN (Z.Z.); Division of Cardiology, Duke University, Durham, NC (T.Y.W.); Division of Cardiology, University of Colorado, Aurora (P.M.H.); and VA Eastern Colorado HealthCare System, Denver, CO (P.M.H.). supriyashore@hotmail.com.
authors: Supriya
authors: S
authors: Shore
authors: From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (S.S.); Department of Public Health, Faculty of Medicine & Health Sciences, Ghent University, Belgium (K.G.S.); Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.F.K., P.G.J., S.V.A., D.J.C., J.A.S.); University of Missouri Kansas City, Kansas City (K.G.S., S.V.A., D.J.C., J.A.S.); Division of Cardiology, Saint Louis University, MO (J.M.S.); Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN (Z.Z.); Division of Cardiology, Duke University, Durham, NC (T.Y.W.); Division of Cardiology, University of Colorado, Aurora (P.M.H.); and VA Eastern Colorado HealthCare System, Denver, CO (P.M.H.).
authors: Kim G
authors: KG
authors: Smolderen
authors: From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (S.S.); Department of Public Health, Faculty of Medicine & Health Sciences, Ghent University, Belgium (K.G.S.); Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.F.K., P.G.J., S.V.A., D.J.C., J.A.S.); University of Missouri Kansas City, Kansas City (K.G.S., S.V.A., D.J.C., J.A.S.); Division of Cardiology, Saint Louis University, MO (J.M.S.); Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN (Z.Z.); Division of Cardiology, Duke University, Durham, NC (T.Y.W.); Division of Cardiology, University of Colorado, Aurora (P.M.H.); and VA Eastern Colorado HealthCare System, Denver, CO (P.M.H.).
authors: Kevin F
authors: KF
authors: Kennedy
authors: From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (S.S.); Department of Public Health, Faculty of Medicine & Health Sciences, Ghent University, Belgium (K.G.S.); Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.F.K., P.G.J., S.V.A., D.J.C., J.A.S.); University of Missouri Kansas City, Kansas City (K.G.S., S.V.A., D.J.C., J.A.S.); Division of Cardiology, Saint Louis University, MO (J.M.S.); Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN (Z.Z.); Division of Cardiology, Duke University, Durham, NC (T.Y.W.); Division of Cardiology, University of Colorado, Aurora (P.M.H.); and VA Eastern Colorado HealthCare System, Denver, CO (P.M.H.).
authors: Philip G
authors: PG
authors: Jones
authors: From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (S.S.); Department of Public Health, Faculty of Medicine & Health Sciences, Ghent University, Belgium (K.G.S.); Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.F.K., P.G.J., S.V.A., D.J.C., J.A.S.); University of Missouri Kansas City, Kansas City (K.G.S., S.V.A., D.J.C., J.A.S.); Division of Cardiology, Saint Louis University, MO (J.M.S.); Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN (Z.Z.); Division of Cardiology, Duke University, Durham, NC (T.Y.W.); Division of Cardiology, University of Colorado, Aurora (P.M.H.); and VA Eastern Colorado HealthCare System, Denver, CO (P.M.H.).
authors: Suzanne V
authors: SV
authors: Arnold
authors: From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (S.S.); Department of Public Health, Faculty of Medicine & Health Sciences, Ghent University, Belgium (K.G.S.); Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.F.K., P.G.J., S.V.A., D.J.C., J.A.S.); University of Missouri Kansas City, Kansas City (K.G.S., S.V.A., D.J.C., J.A.S.); Division of Cardiology, Saint Louis University, MO (J.M.S.); Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN (Z.Z.); Division of Cardiology, Duke University, Durham, NC (T.Y.W.); Division of Cardiology, University of Colorado, Aurora (P.M.H.); and VA Eastern Colorado HealthCare System, Denver, CO (P.M.H.).
authors: David J
authors: DJ
authors: Cohen
authors: From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (S.S.); Department of Public Health, Faculty of Medicine & Health Sciences, Ghent University, Belgium (K.G.S.); Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.F.K., P.G.J., S.V.A., D.J.C., J.A.S.); University of Missouri Kansas City, Kansas City (K.G.S., S.V.A., D.J.C., J.A.S.); Division of Cardiology, Saint Louis University, MO (J.M.S.); Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN (Z.Z.); Division of Cardiology, Duke University, Durham, NC (T.Y.W.); Division of Cardiology, University of Colorado, Aurora (P.M.H.); and VA Eastern Colorado HealthCare System, Denver, CO (P.M.H.).
authors: Joshua M
authors: JM
authors: Stolker
authors: From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (S.S.); Department of Public Health, Faculty of Medicine & Health Sciences, Ghent University, Belgium (K.G.S.); Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.F.K., P.G.J., S.V.A., D.J.C., J.A.S.); University of Missouri Kansas City, Kansas City (K.G.S., S.V.A., D.J.C., J.A.S.); Division of Cardiology, Saint Louis University, MO (J.M.S.); Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN (Z.Z.); Division of Cardiology, Duke University, Durham, NC (T.Y.W.); Division of Cardiology, University of Colorado, Aurora (P.M.H.); and VA Eastern Colorado HealthCare System, Denver, CO (P.M.H.).
authors: Zhenxiang
authors: Z
authors: Zhao
authors: From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (S.S.); Department of Public Health, Faculty of Medicine & Health Sciences, Ghent University, Belgium (K.G.S.); Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.F.K., P.G.J., S.V.A., D.J.C., J.A.S.); University of Missouri Kansas City, Kansas City (K.G.S., S.V.A., D.J.C., J.A.S.); Division of Cardiology, Saint Louis University, MO (J.M.S.); Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN (Z.Z.); Division of Cardiology, Duke University, Durham, NC (T.Y.W.); Division of Cardiology, University of Colorado, Aurora (P.M.H.); and VA Eastern Colorado HealthCare System, Denver, CO (P.M.H.).
authors: Tracy Y
authors: TY
authors: Wang
authors: From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (S.S.); Department of Public Health, Faculty of Medicine & Health Sciences, Ghent University, Belgium (K.G.S.); Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.F.K., P.G.J., S.V.A., D.J.C., J.A.S.); University of Missouri Kansas City, Kansas City (K.G.S., S.V.A., D.J.C., J.A.S.); Division of Cardiology, Saint Louis University, MO (J.M.S.); Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN (Z.Z.); Division of Cardiology, Duke University, Durham, NC (T.Y.W.); Division of Cardiology, University of Colorado, Aurora (P.M.H.); and VA Eastern Colorado HealthCare System, Denver, CO (P.M.H.).
authors: P Michael
authors: PM
authors: Ho
authors: From the Division of Cardiology, Emory University School of Medicine, Atlanta, GA (S.S.); Department of Public Health, Faculty of Medicine & Health Sciences, Ghent University, Belgium (K.G.S.); Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., K.F.K., P.G.J., S.V.A., D.J.C., J.A.S.); University of Missouri Kansas City, Kansas City (K.G.S., S.V.A., D.J.C., J.A.S.); Division of Cardiology, Saint Louis University, MO (J.M.S.); Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN (Z.Z.); Division of Cardiology, Duke University, Durham, NC (T.Y.W.); Division of Cardiology, University of Colorado, Aurora (P.M.H.); and VA Eastern Colorado HealthCare System, Denver, CO (P.M.H.).
authors: John A
authors: JA
authors: Spertus
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D009204:Myocardial Revascularization / Q000009:adverse effects; D010359:Patient Readmission; D011237:Predictive Value of Tests; D057216:Propensity Score; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States
keywords: health status; heart; myocardial infarction; quality of life