The Impact of Early Follow-up on Readmission Rates in AMI Patients
| Status: | Recruiting |
|---|---|
| Conditions: | Cardiology |
| Therapuetic Areas: | Cardiology / Vascular Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 1/19/2018 |
| Start Date: | March 2014 |
| End Date: | December 2019 |
| Contact: | Jennifer Rymer, MD |
| Email: | jennifer.rymer@duke.edu |
| Phone: | 919 668 8002 |
The Impact of Early Versus Standard Post-Discharge Follow-up on Readmission Rates in Patients Admitted With Myocardial Infarction
With no prior prospective study to demonstrate the benefit of an early post-discharge
follow-up appointment in reducing readmission rates in the post-myocardial infarction (MI
patient population, we propose to conduct the first randomized, prospective trial to better
elucidate the association between early and standard follow-up on readmission rates. The
investigators hypothesize that unlike heart failure or advanced valvular disease patients,
the benefit of early outpatient follow-up in reducing readmission of post-MI patients will be
less clear. Thus, the investigators primary aim will be to determine the effect of early
outpatient follow-up post-discharge on 90 day all-cause readmission rates (exclusive of
planned readmissions known at the time of discharge). Secondary aims are to describe 1)
causes of readmissions within 90 days, 2) any cardiovascular-related complications and any
deaths that occur from discharge through 90 days, 3) 30-day readmission rates and 4) median
time to readmission among those readmitted. Finally, the investigators will examine the
distribution of demographic, clinical and socioeconomic characteristic according to
readmission vs. no readmission. The investigators do not expect to have sufficient endpoints
for full predictive modeling, but believe this exploratory work will provide a foundation for
future studies. The investigators postulate that the design and methodology of our current
study could be used to answer similar questions in other subsets of patients.
follow-up appointment in reducing readmission rates in the post-myocardial infarction (MI
patient population, we propose to conduct the first randomized, prospective trial to better
elucidate the association between early and standard follow-up on readmission rates. The
investigators hypothesize that unlike heart failure or advanced valvular disease patients,
the benefit of early outpatient follow-up in reducing readmission of post-MI patients will be
less clear. Thus, the investigators primary aim will be to determine the effect of early
outpatient follow-up post-discharge on 90 day all-cause readmission rates (exclusive of
planned readmissions known at the time of discharge). Secondary aims are to describe 1)
causes of readmissions within 90 days, 2) any cardiovascular-related complications and any
deaths that occur from discharge through 90 days, 3) 30-day readmission rates and 4) median
time to readmission among those readmitted. Finally, the investigators will examine the
distribution of demographic, clinical and socioeconomic characteristic according to
readmission vs. no readmission. The investigators do not expect to have sufficient endpoints
for full predictive modeling, but believe this exploratory work will provide a foundation for
future studies. The investigators postulate that the design and methodology of our current
study could be used to answer similar questions in other subsets of patients.
Inclusion Criteria:
- Patients with acute MI (STEMI or NSTEMI) will be recruited from the PAC-CCU service
and may have been admitted through the Duke Emergency Department or transferred from a
referring hospital. - Clinical events and treatment during the hospitalization (e.g.,
medical management versus cardiac catheterization, ICU vs. non-ICU care, choice of
medications, etc.) will not influence inclusion in the trial and inclusion in the
trial will not influence treatment during hospitalization or during follow up, except
for the timing of the follow-up appointment.
Exclusion Criteria:
- Patients treated with coronary artery bypass grafting will be excluded for the
purposes of this trial to avoid conflicts with usual post-operative management.
- Additionally, patients with features or clinical courses that would preclude the
possibility of readmission will be excluded.
- Examples include transition of care goals to comfort care, transition of care to
inpatient or outpatient hospice, or the development of complications during the
hospitalization that require early follow up appointments (e.g., diagnosis of
malignancy).
- Patients discharged to skilled nursing facilities will be eligible for this study.
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