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Acute Coronary Syndrom

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Original Research2018 Sep;29(6):502-510.

JOURNAL：Coron Artery Dis. Article Link

Sex differences in discharge destination following acute myocardial infarction

Perl L, Peiffer V, Fuhrer AE et al. Keywords: Sex differences; discharge destination; AMI; cohort study

ABSTRACT

BACKGROUND - Despite advancements in treatment, acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality in the elderly population. Previous research has highlighted long-standing sex disparities in the care of these patients. However, differences in the patterns of discharge are not well described. One key parameter is the destination of discharge, and in particular - discharge to skilled nursing facilities (SNFs), a factor associated with worse prognosis and greater costs to the healthcare system. Our aim, therefore, was to observe destination differences after AMI on the basis of sex and other baseline characteristics.


MATERIALS AND METHODS - From a cohort of 143 180 claims, we carried out an observational analysis of 6123 Medicare beneficiaries discharged following AMI during the first quarter of 2016.


RESULTS - For patients who were referred from SNF, the rates of in-hospital death are higher, even after adjustment for baseline characteristics (odds ratio: 1.78, 95% confidence interval: 1.17-2.70). Of those discharged to SNF or home, 36.33% of the female patients were discharged to an SNF versus 25.12% (P<0.01) of the male patients. After adjusting for baseline characteristics, dischargeto SNF remained significantly higher among female patients (odds ratio: 1.57, 95% confidence interval: 1.27-1.94).


CONCLUSION - Discharge to SNF following AMI is more frequent for female patients, even after adjustment for risk factors. Our findings highlight the need to better characterize this unique patient population and understand the cycle of care that they receive following AMI.

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