Original Article

Hospital Readmission Rates Following AMI: Potential Interventions to Improve Efficiency

Authors: Jennifer T. Nguyen, BS, Kairav Vakil, MD, Selcuk Adabag, MD, Anders Westanmo, PharmD, Richard Madlon-Kay, MD, Areef Ishani, MD, Santiago Garcia, MD, Edward O. McFalls, MD, PhD


Objectives: Quality of care utilization measures for patients admitted to the hospital with an acute myocardial infarction (AMI) include length of stay (LOS) and 30-day readmission rates. Our aim was to test whether efforts resulting in reduced LOS in patients diagnosed as having AMI would result in a higher risk of readmission within 30 days of hospital discharge and whether specific interventions could be targeted to reduce readmissions.

Methods: Using data supplied by the Veterans Affairs Inpatient Evaluation Center, we analyzed both the readmissions within 30 days of an AMI and LOS and determined the timing of readmissions and associated diagnoses.

Results: During 2013–2015, 35 (13.3%) of 263 patients with AMI were readmitted within 30 days of discharge compared with 19 (13.4%) of 142 patients during 2016 (not significant). During the same time, LOS was <3 days in most patients. From 2013 to 2015, the initial hospital time was 6 ± 6 days, whereas time out of the hospital before readmission was 11 ± 8 days; these times did not differ from 2016. Initial therapeutic decisions were based on coronary anatomy in >90% of patients with a decision to proceed with revascularization in most patients. Diagnoses during readmission to the hospital were also similar during early and later time periods and most frequently were a result of either coronary artery bypass grafting–related complications from the initial hospitalization or elective coronary artery bypass grafting. Acute coronary syndrome–related diagnoses and recurrent noncardiac causes of chest pain also were common diagnoses during both time periods and did not involve extensive workup during the readmission.

Conclusions: Readmissions for patients with AMI were stable during a 4-year period, at a time that efforts to reduce LOS were emphasized. Because a significant proportion of readmissions involved noncardiac sources of chest pain, improved communication between the emergency department and in-patient cardiology services at the time of triage may be a feasible way to improve efficiency of utilization.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Brown JR, Chang CH, Zhou W, et al. Health system characteristics and rates of readmission after acute myocardial infarction in the United States. J Am Heart Assoc 2014;3:e000714.
2. Chen HY, Tisminetzky M, Lapane KL, et al. Decade-long trends in 30-day rehospitalization rates after acute myocardial infarction. J Am Heart Assoc 2015;4:e002291.
3. Desai MM, Stauffer BD, Feringa HH, et al. Statistical models and patient predictors of readmission for acute myocardial infarction: a systematic review. Circ Cardiovasc Qual Outcomes 2009;2:500-507.
4. Krumholz HM, Hsieh A, Dreyer RP, et al. Trajectories of risk for specific readmission diagnoses after hospitalization for heart failure, acute myocardial infarction, or pneumonia. PLoS One 2016;11:e0160492.
5. Nuti SV, Qin L, Rumsfeld JS, et al. Association of admission to Veterans Affairs hospitals vs non-Veterans Affairs hospitals with mortality and readmission rates among older men hospitalized with acute myocardial infarction, heart failure, or pneumonia. JAMA 2016;315:582-592.
6. Sangu PV, Ranasinghe I, Aliprandi Costa B, et al. Trends and predictors of rehospitalisation following an acute coronary syndrome: report from the Australian and New Zealand population of the Global Registry of Acute Coronary Events (GRACE). Heart 2012;98:1728-1731.
7. Stefan MS, Pekow PS, Nsa W, et al. Hospital performance measures and 30-day readmission rates. J Gen Intern Med 2013;28:377-385.
8. Tisminetzky M, McManus DD, Erskine N, et al. Thirty-day hospital readmissions in patients with non-ST-segment elevation acute myocardial infarction. Am J Med 2015;128:760-765.
9. Doll JA, Hellkamp A, Thomas L, et al. Effectiveness of cardiac rehabilitation among older patients after acute myocardial infarction. Am Heart J 2015;170:855-864.
10. Doll JA, Tang F, Cresci S, et al. Change in angina symptom status after acute myocardial infarction and its association with readmission risk: an analysis of the Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status (TRIUMPH) Registry. J Am Heart Assoc 2016;5:e003205.
11. Donze J, Aujesky D, Williams D, et al. Potentially avoidable 30-day hospital readmissions in medical patients: derivation and validation of a prediction model. JAMA Intern Med 2013;173:632-638.
12. Hess CN, Shah BR, Peng SA, et al. Association of early physician follow-up and 30-day readmission after non-ST-segment-elevation myocardial infarction among older patients. Circulation 2013;128:1206-1213.
13. Lambert-Kerzner A, Del Giacco EJ, Fahdi IE, et al. Patient-centered adherence intervention after acute coronary syndrome hospitalization. Circ Cardiovasc Qual Outcomes 2012;5:571-576.
14. Hansen LO, Young RS, Hinami K, et al. Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med 2011;155:520-528.
15. Kaboli PJ, Go JT, Hockenberry J, et al. Associations between reduced hospital length of stay and 30-day readmission rate and mortality: 14-year experience in 129 Veterans Affairs hospitals. Ann Intern Med 2012;157:837-845.
16. Li Q, Lin Z, Masoudi FA, et al. National trends in hospital length of stay for acute myocardial infarction in China. BMC Cardiovasc Disord 2015;15:9.
17. Saczynski JS, Lessard D, Spencer FA, et al. Declining length of stay for patients hospitalized with AMI: impact on mortality and readmissions. Am J Med 2010;123:1007-1015.
18. Wasfy JH, Zigler CM, Choirat C, et al. Readmission rates after passage of the Hospital Readmissions Reduction Program: a pre-post analysis. Ann Intern Med 2017;166:324-331.
19. Tung YC, Chang GM, Chang HY, et al. Relationship between early physician follow-up and 30-day readmission after acute myocardial infarction and heart failure. PLoS One 2017;12:e0170061.