In-hospital versus postdischarge 30-day mortality in patients admitted after acute myocardial infarction (AMI), cerebral stroke or hip fracture: a cohort study based on registry data.

Abstract

Background: 30-day mortality is frequently used to monitor and improve patient safety and quality of care. In this study, we compare 30-day mortality according to place of death, that is, during admission (in-hospital), postdischarge or after readmission for patients with acute myocardial infarction (AMI), cerebral stroke and hip fracture.

Methods: Administrative data for patients admitted with AMI, cerebral stroke and hip fractures to Norwegian hospitals between 2017 and 2019 were obtained from the Norwegian Patient Registry, enabling the estimation of mortality and readmission proportions.

Results: A total of 84 212 admissions with AMI (38%), cerebral stroke (32%) and hip fracture (30%) were included. 30-day mortality was 9.2% for patients admitted with AMI, 11.4% for stroke and 8.7% for hip fractures. Among these, a substantial proportion died after discharge from their initial hospital stay with 23.4% of the deaths following AMI, 32.8% for stroke and 59.0% for hip fracture, respectively.

Conclusion: This study demonstrates a substantial proportion of 30-day mortality following AMI, stroke and hip fractures occurring postdischarge, emphasising the importance of monitoring outcomes beyond hospital stays. Mortality patterns varied by age, length of stay and comorbidity burden, indicating a need for tailored postdischarge strategies, particularly for older adults and patients with complex health conditions. We believe that the findings may indicate a need for targeted interventions and follow-up care to improve outcomes for high-risk groups. Further research is recommended to refine these strategies and enhance patient care across healthcare settings.