Abstract
BackgroundPatients with acute coronary syndromes often experience non-specific (generic) pain after hospital discharge. However, evidence about the association between post-discharge non-specific pain and rehospitalization remains limited.MethodsWe analyzed data from the Transitions, Risks, and Actions in Coronary Events Center for Outcomes Research and Education (TRACE-CORE) prospective cohort. TRACE-CORE followed patients with acute coronary syndromes for 24 months post-discharge from the index hospitalization, collected patient-reported generic pain (using SF-36) and chest pain (using the Seattle Angina Questionnaire) and rehospitalization events. We assessed the association between generic pain and 30-day rehospitalization using multivariable logistic regression (N = 787). We also examined the associations among patient-reported pain, pain documentation identified by natural language processing (NLP) from electronic health record (EHR) notes, and the outcome.ResultsPatients were 62 years old (SD = 11.4), with 5.1% Black or Hispanic individuals and 29.9% women. Within 30 days post-discharge, 87 (11.1%) patients were re-hospitalized. Patient-reported mild-to-moderate pain, without EHR documentation, was associated with 30-day rehospitalization (odds ratio [OR]: 2.03, 95% confidence interval [CI]: 1.14–3.62, reference: no pain) after adjusting for baseline characteristics; while patient-reported mild-to-moderate pain with EHR documentation (presumably addressed) was not (OR: 1.23, 95% CI: 0.52–2.90). Severe pain was also associated with 30-day rehospitalization (OR: 3.16, 95% CI: 1.32–7.54), even after further adjusting for chest pain (OR: 2.59, 95% CI: 1.06–6.35).ConclusionsPatient-reported post-discharge generic pain was positively associated with 30-day rehospitalization. Future studies should further disentangle the impact of cardiac and non-cardiac pain on rehospitalization and develop strategies to support the timely management of post-discharge pain by healthcare providers.
Highlights
Patients with acute coronary syndromes often experience non-specific pain after hospital discharge
We examined pain reported by TRACE-CORE patients at one month post-discharge and its association with 30-day rehospitalization
Compared with all TRACE-CORE participants (N = 2174), the patients analyzed in our study (N = 787) had similar mean age (62 vs. 61), less females (29.9% vs. 33.5%), more non-Hispanic white (94.9% vs. 81.0%), and better socioeconomic status
Summary
Patients with acute coronary syndromes often experience non-specific (generic) pain after hospital discharge. Evidence about the association between post-discharge non-specific pain and rehospitalization remains limited. Coronary heart disease affects 18.2 million adult Americans and over 1.3 million yearly hospitalizations involve acute coronary syndrome [1]. The transition from hospital to home can be challenging for patients. Chen et al BMC Cardiovasc Disord (2021) 21:383 experience warning symptoms after hospital discharge, leading them back to seek acute care [2,3,4]. The 30-day rehospitalization rate for adult patients (≥ 18 year of age) has ranged from 10 to 17% [1, 5, 6]
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