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Published on: February 26, 2013
Effect of leaving against medical advice on 30-day infective endocarditis readmissions
Harshith S Thyagaturu1, Alexander Bolton2, Sittinun Thangjui3
1Department of Cardiology, Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia, USA.
Insights
Patients with infective endocarditis (IE) leaving against medical advice (AMA) face significantly higher 30-day readmission risks. Addressing this requires understanding the high prevalence of injection drug use and mental health needs in IE AMA patients.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- The impact of patients leaving against medical advice (AMA) on infective endocarditis (IE) readmission rates remains understudied.
- Infective endocarditis is a serious condition with significant healthcare implications.
Purpose of the Study:
- To investigate the association between leaving against medical advice (AMA) and 30-day readmission rates in infective endocarditis (IE) patients.
- To compare the characteristics and readmission risks of IE patients discharged AMA versus those discharged conventionally.
Main Methods:
- Utilized the National Readmissions Database (2016-2019) to identify IE patients.
- Categorized patients into those discharged AMA (IE AMA) and those discharged to home or facility (IE non-AMA).
- Analyzed 30-day all-cause readmissions as the primary outcome, adjusting for patient characteristics.
Main Results:
- 16.3% of 26,481 IE patients were discharged AMA.
- IE AMA patients were younger and had higher injection drug use (IDU) rates but fewer comorbidities.
- IE AMA patients demonstrated a 3.1-fold increased hazard for 30-day readmissions (HR: 3.1; p < 0.01).
Conclusions:
- Infective endocarditis patients discharged AMA face substantially higher 30-day readmission risks.
- Higher resource utilization is observed for IE AMA readmissions.
- Further research into mental health interventions for IE AMA patients with high IDU prevalence is warranted to reduce readmission burdens.
Background:
The burden of against medical advice (AMA) discharges on the readmission rate of infective endocarditis (IE) patients has been largely ignored.
Methods:
We used the National Readmissions Database, years 2016 to 2019, to identify IE patients and categorized them into those who left AMA (IE AMA) and those who were discharged to home or skilled nursing facility (SNF)/other facility (IE non-AMA). The primary outcome was 30-day all-cause readmissions difference per AMA status.
Results:
Of 26,481 patients with IE who met the inclusion criteria, 4,310 (16.3%) left the hospital AMA. IE AMA patients were younger (mean years; 43.7 vs 34.2; p < 0.01) and had a higher prevalence of injection drug use (IDU) (89.4% vs 45.2%; p < 0.01) but fewer comorbidities compared to IE non-AMA. In adjusted analyses, IE AMA had higher hazards for 30-day readmissions compared to IE non-AMA [hazards ratio (HR): 3.1 (2.9-3.5); p < 0.01].
Conclusion:
IE AMA are at increased risk of 30-day readmissions and higher resource utilization at the time of readmission compared to IE non-AMA. Considering the high prevalence of IDU in IE AMA, the role of mental health to curb the burden of IE readmissions is an area of further research.
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