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Published on: February 16, 2011
Discharge against medical advice after hospitalisation for acute myocardial infarction
Chun Shing Kwok1,2, Mary Norine Walsh3, Annabelle Volgman4
1Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK.
Insights
Discharge against medical advice (AMA) in acute myocardial infarction (AMI) patients occurs in 1.5% and significantly increases readmission risk. Interventions are needed to reduce AMA discharges and prevent adverse outcomes.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Discharge against medical advice (AMA) is infrequent but linked to adverse patient outcomes.
- Limited data exists on AMA discharges within national acute myocardial infarction (AMI) cohorts.
- Understanding AMA's impact on AMI readmissions is crucial for patient care.
Purpose of the Study:
- To evaluate the incidence of AMA discharges in patients with AMI.
- To determine the association between AMA discharge and 30-day unplanned readmissions in AMI patients.
- To identify specific causes of readmission for patients discharged AMA.
Main Methods:
- A retrospective cohort study utilizing the Nationwide Readmission Database (2010-2014).
- Inclusion criteria: patients admitted with AMI in the USA.
- Analysis involved descriptive statistics and logistic regression to assess readmission predictors.
Main Results:
- The rate of AMA discharge for AMI remained stable at 1.5% from 2010-2014.
- AMA discharge independently predicted unplanned all-cause readmissions (OR 2.27).
- Patients discharged AMA had higher readmission rates for AMI (30.4% vs 13.4%) and neuropsychiatric reasons (3.2% vs 1.3%).
Conclusions:
- AMA discharge affects 1.5% of AMI patients, elevating their risk for early re-infarction readmission.
- Targeted interventions are necessary to mitigate AMA discharges in high-risk AMI populations.
- Reducing AMA discharges can prevent adverse outcomes and decrease hospital readmissions.
Background:
Discharge against medical advice (AMA) occurs infrequently but is associated with poor outcomes. There are limited descriptions of discharges AMA in national cohorts of patients with acute myocardial infarction (AMI). This study aims to evaluate discharge AMA in AMI and how it affects readmissions.
Methods:
We conducted a cohort study of patients with AMI in USA in the Nationwide Readmission Database who were admitted between the years 2010 and 2014. Descriptive statistics were presented for variables according to discharge home or AMA. The primary end point was all-cause 30-day unplanned readmissions and their causes.
Results:
2663 019 patients were admitted with AMI of which 10.3% (n=162 070) of 1569 325 patients had an unplanned readmission within 30 days. The crude rate of discharge AMA remained stable between 2010 and 2014 at 1.5%. Discharge AMA was an independent predictor of unplanned all-cause readmissions (OR 2.27 95% CI 2.14 to 2.40); patients who discharged AMA had >twofold increased crude rate of readmission for AMI (30.4% vs 13.4%) and higher crude rate of admissions for neuropsychiatric reasons (3.2% vs 1.3%). After adjustment, discharge AMA was associated with increased odds of readmissions for AMI (OR 3.65 95% CI 3.31 to 4.03, p<0.001). We estimate that there are 1420 excess cases of AMI among patients who discharged AMA.
Conclusions:
Discharge AMA occurs in 1.5% of the population with AMI and these patients are at higher risk of early readmissions for re-infarction. Interventions should be developed to reduce discharge AMA in high-risk groups and initiate interventions to avoid adverse outcomes and readmission.
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