Factors related to hospital readmission of patients with acute coronary syndrome: a prospective cohort study

Background

Hospital readmissions of patients with acute coronary syndrome (ACS) are frequent and associated with poor clinical outcomes and increased costs to the healthcare services. Identifying factors that might be associated with hospital readmission is important to support preventive interventions.

Purpose

To identify factors related to hospital readmission of patients with ACS.

Methods

A prospective cohort study. Patients hospitalized with ACS for the first time were included in the study. The outcome, hospital readmission for ACS, was assessed at 30 days, 6 months and 1 year after index discharge. Modifiable cardiovascular risk factors (arterial hypertension, dyslipidemia, diabetes mellitus, smoking, degree of addiction to smoking, use of alcohol, physical inactivity, obesity, stress, depression, excessive daytime sleepiness, obstructive sleep apnea syndrome, hormone replacement) and non-modifiable risk factors (age, race, family history of coronary heart disease) were evaluated as potential predictors of the outcome. Other variables that might have contributed to readmission were also included: marital status, family income, occupation, education, adherence to medication and type of treatment (clinical, percutaneous coronary intervention or coronary artery bypass grafting). The association between hospital readmission and potential predictors was assessed using the Log-Rank test and Cox's simple regression model. Factors whose associations had a p-value of less than 0.20 in the simple regression and other variables of clinical interest were evaluated in a Cox multiple regression model, with p<0.05 considered significant. The study was approved by two Research Ethics Committees.

Results

216 patients were included and the incidence of readmission was 15.7%. Most of the patients were male, white, married, had an income between two and four minimum wages, and a mean age of 60 years. Half of the patients had high adherence to medication. The cardiovascular risk factors identified in most patients were sedentary lifestyle (79.6%), arterial hypertension (63.4%) and obstructive sleep apnea (51.9%). The only independent predictor for readmission was surgical treatment (p=0.026).

Conclusions

Participants had several cardiovascular risk factors and the predictor of hospital readmission was surgical treatment. Identifying the predictive factors of a given population helps nurses in planning and guiding hospital discharge.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Conselho Nacional de Desenvolvimento Científico e Tecnolόgico (CNPq)