CardioExchange Archive

STEMI (ST-segment elevation myocardial infarction) patients in the U.S. are more likely to be readmitted to the hospital within 30 days compared with patients outside the U.S., but this difference loses significance when length of stay (LOS) is taken into account, according to a new study published in JAMA. 

Robb Kociol and colleagues, analyzing data from 5745 STEMI patients enrolled in the Assessment of Pexelizumab in Acute Myocardial Infarction trial, found that U.S. patients had a 68% increase in the risk of readmission compared with patients outside the U.S.

• 30-day readmission rates: 14.5% in the U.S. versus 9.9% in other countries (p<0.001)
• The median LOS was shortest in the U.S. (3 days) and longest in Germany (8 days).

U.S. patients had a significantly elevated risk of readmission at 30 days (OR 1.53, CI 1.20-1.96), but this risk completely disappeared when LOS was included in the model (OR 0.98, CI 0.69-1.40). Each 1-day increase in the country-level LOS was associated with a 17% reduction in the likelihood of readmission at 30 days.

In their comments, the author note that some observers have suggested “that LOS has declined too far in the United States, resulting in suboptimal outcomes” and that “this trend may be driven by a health care system that financially rewards early discharge.” However, they point out, “LOS may be a marker for a combination of differences in health care patterns across different countries.” Balancing LOS and readmissions can be complex, they further point out: “The economic tradeoff between prolonging index hospital stays and reducing readmissions needs further research because the former may simply decrease overall efficiency without a significant effect on outcomes or overall resource use.”