Differences In Short-term Observation Post-hospitalization And Readmission Predictors In Cardiac Rehabilitation Participants And Non-participants

Abstract

While prior studies have investigated hospital readmissions for subsequent cardiac events in patients with cardiovascular disease these studies have been limited to 30-day readmissions and have ignored short term observation (STO, hospitalizations < 48 hours). PURPOSE: The purpose of this study was to assess predictors of STO and readmission at 60 and 180 days after initial hospitalization in cardiac patients who either did or did not participate in cardiac rehabilitation (CR). METHODS: Of the 245 patients studied who were referred to Phase II CR following cardiac diagnosis only 45 patients elected to participate in CR. Patients 60 and 180-day readmission and STO rates were recorded. Several factors which had been previously identified as potential predictors of 30-day readmission rates were recorded. Stepwise regression analyses were then used to identify which of these variables were significant predictors of readmission and STO rates at 60 and 180 days. RESULTS: Readmission at 30 days, age, number of atherosclerotic lesions treated at the time of hospitalization, history of depression, unemployed status, and no β-blocker prescription at discharge were all significant predictors of readmission at 60 days. Length of stay after initial event, history of COPD, history of depression, prescribed antiplatelet medication at discharge, being uninsured, number of lesions treated, hypertensive status, and no prescription for angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACE/ARB) at discharge were predictors of readmission at 180 days. Significant predictors for STO at 60 days were length of initial hospital stay, tobacco use, and absence of heart failure. Predictors for 180-day STO were cardiac arrest upon arrival, chest pain with admission, no ACE/ARB at discharge, severity of myocardial infarction, CR participation, tobacco use, and insurance status ([INCREMENT]R2 ≥ 0.061, p < 0.01 for all). CONCLUSION: Predictors of readmission and STO rates at 60 and 180 days could be grouped as: cardiac event severity (e.g., number of lesions, length of hospital stay), presence of comorbidities (e.g., COPD, depression), prescription medications (e.g., ACE/ARB, β-blocker), financial status (e.g., being unemployed, uninsured), and behavioral factors (e.g., tobacco use, CR participation).