NEW YORK (Reuters Health) - Myocardial infarction (MI) patients who are transferred to another hospital for care are less likely to be followed up and more likely to be readmitted to the hospital, new findings show.
"This group of patients may represent a vulnerable population and we really need to come up with specific strategies to make their post-discharge transition back to their local community as seamless as possible," corresponding author Dr. Amit Vora, of Duke University in Durham, North Carolina, told Reuters Health.
Many patients admitted to their local hospital for acute MI must be transferred to another hospital for care, for example, to receive revascularization, Dr. Vora and his team note in their report, to be published online in Circulation: Cardiovascular Quality and outcomes. Logistical factors may lead to poor communication and coordination when it's time for the patient to be transferred back to their community, they add, which could be particularly problematic for older patients who may have more comorbidity and require closer follow-up after discharge.
To investigate, the researchers looked at outcomes for 39,136 acute MI patients 65 and older who were treated between 2007 and 2010 at 451 hospitals participating in Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines.
Thirty-six percent of patients were transferred to another hospital for acute MI care, traveling a median of 43 miles.Within 30 days of discharge, 69.9% of the transferred patients had received outpatient follow-up, versus 78.2% of direct-arrival patients.
The adjusted risk of readmission for any cause was 14.5% for transferred patients versus 14% for direct-admit patients, while the risk of readmission for cardiovascular causes was 9.5% for
transferred patients and 9.1% for the direct-admit patients.However, the risk adjusted 30-day mortality was 1.6% for each group.
"Post-discharge care for acute MI patients is a performance measure, and we do track how often these patients are admitted
to the hospital following their discharge," Dr. Vora said. "A big focus of quality improvement is identifying strategies to reduce rehospitalization."
The next step in the research will be to identify the specific barriers to receiving follow-up care for transferred patients, he added, and then "define clear pathways and clear plans following discharge to ensure that these patients receive the care and the follow-up that they need."
The Agency for Healthcare Research and Quality funded this research. Three coauthors reported relevant relationships.