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P1708 - Major Adverse Cardiovascular Events and Hospital Readmissions in the 90 Days Following Acute Myocardial Infarction: Redefining the Risk Period

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Author Block: Keith Allen, Mid America Heart and Lung Surgeons, Kansas City, MO; Christopher Young, James Alexander, Susan Gabriel
Disclosure Block: K.Allen: Honoraria; Modest; CSL Behring. C.Young: None. J.Alexander: Other; Significant; CSL Behring. S.Gabriel: Employment; Significant; CSL Behring.
Introduction: Centers for Medicare & Medicaid Services (CMS) has implemented a voluntary bundled payment program centered on a 90-day period for acute myocardial infarction (AMI) to increase the quality of care and reduce costs. Tying payments and penalties to a 90-day period, versus the current 30-day period for quality metrics, redefines the risk period for recurrent events following AMI.
Objective: To quantify the clinical burden of recurrent events in the 30- and 90-day period post AMI.
Methods: A retrospective cohort analysis was conducted of 30- and 90-day major adverse cardiovascular events (MACE: mortality, AMI readmission and stroke), all-cause and cardiac rehospitalization among patients with a primary diagnosis of AMI within a Medicare population.
Results: This analysis included 125,772 Medicare patients. At 90 days, the overall rate of all-cause and cardiac rehospitalization was 23.7% and 13.2%, respectively. The rate of MACE at 90 days was 10.2%. Rates of all outcomes increased significantly between day 30 and day 90 (p<0.0001, Figure 1). Relative increases were observed in all-cause rehospitalization (82.1%), cardiac rehospitalization (77.8%), MACE (99.8%), AMI readmission (374.3%), mortality (82.2%), and stroke (77.8%).
Conclusions: The 90-day period post AMI is associated with significant healthcare burden, with approximately one quarter of AMI episodes associated with hospital readmissions. Rates of outcomes increase substantially between 30 and 90 days post AMI, in particular AMI readmission increases disproportionately relative to the increase in timeframe. These findings represent a significant impact when moving from a 30- to a 90-day payment bundling model.