Readmissions Rates After Myocardial Infarction for Gastrointestinal Bleeding: A National Perspective
Kamesh Gupta1, Ahmad Khan2, Manish Kumar3
1Department of Internal Medicine, UMMS-Baystate Medical Center, Springfield, MA, USA. Kameshg9@gmail.com.
Insights
Gastrointestinal bleeding affects 0.3% of patients after acute myocardial infarction (AMI), leading to significant mortality and healthcare costs. Predictors include age and comorbidities, but AMI treatment type did not influence readmission risk.
Area of Science:
- Cardiology
- Gastroenterology
- Health Services Research
Background:
- Gastrointestinal (GI) bleeding is a frequent complication following acute myocardial infarction (AMI).
- Understanding the incidence, outcomes, and predictors of GI bleeding post-AMI is crucial for patient management and resource allocation.
Purpose of the Study:
- To determine the 30-day incidence of GI bleeding after AMI.
- To investigate in-hospital outcomes, healthcare burden, and predictors of GI bleeding readmission within 30 days of AMI.
Main Methods:
- Utilized data from the Nationwide Readmission Database (2010-2014).
- Included patients with ST or non-ST elevation myocardial infarction, excluding specific criteria.
- Analyzed 30-day readmissions for upper or lower GI bleeding, in-hospital mortality, complications, procedures, length of stay, and hospitalization charges using multivariate logistic regression.
Main Results:
- 0.3% of 3,520,241 patients discharged with AMI were readmitted with GI bleeding within 30 days.
- Lower GI bleeding was more common (60%), with GI cancers and hemorrhoids as suspected sources.
- In-hospital mortality for readmissions was 3.6%; predictors included age, comorbidities (CKD, GI tumor, IBD), and artificial heart valve. AMI treatment type did not impact readmission.
Conclusions:
- The 30-day incidence of GI bleeding after AMI is 0.3% in the US.
- GI bleeding complicating AMI results in considerable in-hospital mortality and significant healthcare costs.
Background And Aims:
Gastrointestinal (GI) bleeding is one most common complications of acute myocardial infarction (AMI). We aimed to determine the incidence, in-hospital outcomes, associated healthcare burden and predictors of GI bleeding within 30 days after AMI.
Methods:
Data were extracted from Nationwide Readmission Database 2010-2014. Patients were included if they had a primary diagnosis of ST or non-ST elevation myocardial infarction. Exclusion criteria were admissioned in December, aged less than 18 years and a diagnosis of type-2 MI. The primary outcome was 30-day readmission with upper or lower GI bleeding. Secondary outcomes were in-hospital mortality, etiology of bleeding, in-hospital complications, procedures, length of stay, and total hospitalization charges. Independent predictors of readmission were identified using multivariate logistic regression analysis.
Results:
Out of the 3,520,241 patients discharged with ACS, 10,018 (0.3%) were readmitted with GI bleeding within 30 days of discharge. 60% had lower GI bleeding. Most common sources suspected were GI cancers in 17% and hemorrhoidal bleeding in 10%. In hospital mortality rate for readmission was 3.6%. Independent predictors of readmission were age, Charlson comorbidity score, history of chronic kidney disease, GI tumor, inflammatory bowel disease and artificial heart valve. Type of treatment for AMI had no impact on readmission. Patients readmitted had higher rates of shock (adjusted odds ratio, 1.48, 95% CI 1.01-3.72).
Conclusions:
In the first nationwide study, 30-day incidence of GI bleeding after AMI is 0.3%. GI bleeding complicating AMI carries a substantial in-hospital mortality and cost of care.
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