Readmission Rates after a heart attack are 35% higher in the US than in comparable countries

January 4, 2012 - An article in today’s edition of the Journal of the American Medical Association (JAMA) compares readmission rates of 5745 heart attack patients in the U.S., Canada, Australia, New Zealand and 13 European countries. It concludes that patients in the U.S. are more likely to be readmitted to the hospital within 30 days of discharge than any of the others, specifically 14% of American patients versus 9% of all other patients were readmitted. The second strongest predictor of readmission after an acute heart episode was that the patient was in the United States.

The article has been followed up by a blog entry on ABCNews.com which offers many reasons for the readmissions, but the one that interested me was made by Dr. Christopher Cannon, professor of medicine at Harvard Medical School. He said that “the issue of not as uniform follow-up after discharge is a system issue for the U.S. Our care is a bit more fragmented, so [it is] not as well-coordinated, and then some patients can fall between the cracks and need readmission to get things re-stabilized.”

The United States’ system with its emphasis on hospital care as well as the fragmented nature of care in the community, confirms once again the understanding that care for chronic conditions such as heart disease requires greater continuity of care, and less fragmentation of care. Even when an acute episode such as a heart attack occurs, there is now evidence that poor engagement with the fragmentation of post hospital care can result in costly and presumably avertable readmissions.

Dr. Ty Gluckman, director of clinical excellence at the Providence Heart and Vascular Institute of Portland Oregon said that “Given the uncertainty about what is the optimal length of stay after a myocardial infarction, it is nonetheless important for patients and their families to engage providers to be better educated about warning symptoms and signs, to better understand the medications they are prescribed and to understand what measures can be taken both short-term and long-term to reduce their cardiovascular risk.”

Educating patients and their families, strengthening programs that help patients participate in their care outside the hospital, and integrating care with community services will not only reduce readmission (and save money), but also improve the patient experience.