Prevalence, causes, and predictors of 30-day readmissions after acute myocardial infarction with ventricular arrhythmias: a cohort study using the 2016-2017 national readmissions database.

Abstract

Background: Patients surviving acute myocardial infarction (AMI) complicated by ventricular arrhythmias (VAs) are at high risk of early post-discharge readmissions due to multiple complications. These readmissions worsen clinical outcomes and add substantial financial strain to the U.S. healthcare system. This study investigates the prevalence, causes, and predictors of 30-day readmissions following hospitalization for AMI complicated by VAs.

Methods and results: Hospitalizations for AMI complicated by VAs were identified from the 2016-2017 Nationwide Readmissions Database. Independent predictors of 30-day readmission were analyzed using multivariable survey-weighted logistic regression in the R statistical software (version 4.5.0). Among 93 588 index hospitalizations, 8154 (8.7%) resulted in 30-day readmissions. In-hospital mortality occurred in 16.43% of index admissions and 5.92% of readmissions. Significant predictors of readmission included older age (OR: 1.01; P < 0.001), female sex (OR: 1.13; P = 0.002), prior heart failure (OR: 1.28; P < 0.001), peripheral vascular disease (OR: 1.18; P = 0.002), COPD (OR: 1.43; P < 0.001), atrial fibrillation (OR: 1.24; P < 0.001), diabetes (OR: 1.29; P < 0.001), previous MI (OR: 1.12; P = 0.009), end-stage renal disease (ESRD) (OR: 1.52; P < 0.001), stroke (OR: 1.52; P < 0.001), and hospital stay >4 days (OR: 1.94; P < 0.001). Higher income quartiles were associated with lower readmission risk. The mean index charges were $151 722, whereas charges per readmission were $64 122.

Conclusions: AMI complicated by VAs is associated with high 30-day readmission rates, driven mainly by noncardiac and select cardiac causes such as heart failure and atrial fibrillation. Enhanced monitoring of high-risk groups may improve outcomes and reduce healthcare costs.