Abstract P569: Social Determinants of Health and 30-day Readmission or Emergency Department Use After Acute Myocardial Infarction

Abstract

Background: A more complete understanding of associations between social determinants of health (SDOH) and 30-day readmission or emergency department (ED) use following hospitalization for acute myocardial infarction (AMI) will facilitate development of targeted interventions and root cause policies to reduce readmissions. Methods: We analyzed 753 adults ≥65 years with linked Medicare data from the REasons for Geographic and Racial Differences in Stroke study who were discharged from the hospital after an adjudicated AMI between 2003-19. We selected SDOH (race, education, income, Medicare+Medicaid, zip code with high poverty, rural residence, living in a Health Professional Shortage Area, and social support) with relative risk for readmission/ED use >1. We grouped participants into 0 or 1, 2, 3, and 4+ SDOH. Poisson models examined crude and fully adjusted associations on risk for readmission/ED visit within 30 days. Results: Participant characteristics: 40% were women, mean age was 77 years, and 29% were readmitted or had an ED visit within 30 days. Compared to those without readmission/ED visit, those readmitted had more cognitive impairment (17 vs 10%) and depressive symptoms (57 vs. 46%); were more likely to be hospitalized in the year prior to AMI (42 vs 28%) and have adjudicated heart failure at index AMI (36 vs 25%); and were less likely to have a physician visit within 10 days (41 vs 32%) and 30 days (0/1 SDOH: 79%, 2: 73%, 3: 66%, 4+: 60%, p trend < 0.0001) (all contrast p<0.05). Participants with 4+ SDOH had higher risk of readmission (Table). Conclusion: 4+ SDOH were associated with higher risk of readmission/ED visit after AMI. Those with the greatest burden of SDOH were also least likely to follow up within 10 or 30 days. Policies such as the American College of Cardiology’s “See You in 7 Challenge” program may be even more effective at reducing readmission after MI if specifically targeted at patients with high burden of SDOH.