Abstract 341: Cost of Care Implications for Unstable Angina and Coronary Revascularization Readmissions Following Acute Myocardial Infarction

Abstract

Objectives: While mortality following acute myocardial infarction (AMI) has decreased over time, subsequent hospitalizations due to unstable angina (UA) and coronary revascularization (CR) continue to be a great source of burden both from a patient’s and a societal perspective. It is unknown, however, how AMI patients who experience these additional readmissions value their health and what the associated costs are, beyond the hospitalization itself. Methods: From TRIUMPH, a 24-center observational AMI registry, we identified patients readmitted for unstable angina (UA) or unplanned CR ≥1 month following index AMI discharge. Propensity matching was used to compare (1) patients who were vs. were not readmitted for UA and (2) patients who were vs. were not readmitted for CR. We examined one-year quality-adjusted life-years (QALYs) using the EQ-5D measurements at 1, 6 and 12 months, as well as post-discharge costs (office visits, cardiac rehabilitation and cardiovascular readmissions, excluding costs for the UA/CR event). Confidence intervals were calculated via bootstrap analysis. Results: A total of 140 (4.26%) were readmitted for UA and 112 (3.41%) patients underwent CR after their AMI. Unadjusted mean 1-year QALYs for UA and non-UA patients were 0.743 and 0.821 [propensity-matched difference -0.076 (95% CI -0.100, -0.042)]. Unadjusted mean 1-year QALYs for CR and non-CR patients were 0.798 and 0.828 [propensity-matched difference -0.032 (95% CI -0.063, -0.003]. Mean differences in costs were $8009 (95% CI $3997, $14229) for UA vs. non-UA patients and $4498 (95% CI $4046, $4966) for CR vs. non-CR patients. Cardiovascular rehospitalizations contributed most to these costs (Table) . Conclusion: In this study, over the year following AMI, patients experiencing UA or unplanned coronary revascularization were challenged in maintaining their health status as compared with those not experiencing the respective event and had significantly higher health care costs.