CLINICAL
NEWS JOURNAL WRAP
Less Follow-up,
More Readmissions
in Transferred AMI
Patients
Many older patients presenting at
a hospital with acute myocardial
infarction (AMI) are transferred to
another hospital for care. According to a new study in Circulation:
Cardiovascular Quality and Outcomes,
while these patients have similar
mortality rates to those who are not
transferred patients are less likely
to receive timely follow-up from a
physician and are more likely to be
readmitted during the first 30 days
after discharge.
Amit N. Vora, MD, MPH,
and colleagues examined 39,136
Medicare patients who received AMI
treatment and coronary revascularization at 451 ACTION-Registry®Get with the GuidelinesTM hospitals
who survived to discharge. A total
of 14,060 (35.9%) of these patients
had been transferred from another
hospital and traveled a median of
43.1 miles. Most referring hospitals
did not have revascularization capabilities and were much smaller than
the receiving hospitals.
Transferred patients were slightly
younger and had lower rates of
previous MI, heart failure and previous revascularization. ST-elevation
myocardial infarction (STEMI)
rates were similar between transferred and direct-arrival patients. In
hospital complications were similar
between groups. At discharge, both
groups had similar rates of prescription for guideline-recommended
secondary prevention medication,
but transferred-in patients were
more likely to be referred for cardiac
rehabilitation.
The median time to first physician follow-up was 16 days for
transferred-in patients and 13 days
for direct-arrival patients. Transferred patients saw higher rates of
all-cause readmission during the first
30 days after discharge. This trend
still existed when only cardiovascular readmissions were considered.
At 30 days, both groups had similar
rates of all-cause mortality and at 1
year there was no evidence of a difference in mortality rates.
20 CardioSource WorldNews
The authors speculate that the
lower rates of follow-up for transferred patients may be due to geographic and logistical challenges
in scheduling patients outside of a
local health-care delivery system.
They write that “early post-discharge
follow-up can help maintain adher-
ence to prescribed secondary prevention medications, afford an opportunity to initiate or titrate therapies, and
reinforce a commitment to risk factor
modification, including weight loss,
smoking cessation, and participation
in cardiac rehabilitation.”
Vora and colleagues wrote in
their conclusion that the findings
“represent an opportunity for
improving post-MI discharge care
coordination among those initially
transferring in.”
Vora, Peterson ED, Hellkamp AS, et al. Circ
Cardiovasc Qual Outcomes. 2016;9:109-16.
Actor Portrayal
Indication
Ranexa is indicated for the
treatment of chronic angina.
Ranexa may be used with
beta-blockers, nitrates, calcium
channel blockers, anti-platelet
therapy, lipid-lowering therapy,
ACE inhibitors, and angiotensin
receptor blockers.
Important Safety Information
Contraindications
Ranexa is contraindicated in patients:
Taking strong inhibitors of CYP3A
(e.g., ketoconazole, itraconazole,
clarithromycin, nefazodone,
nelfinavir, ritonavir, indinavir,
and saquinavir).
Taking inducers of CYP3A (e.g.,
rifampin, rifabutin, rifapentine,
phenobarbital, phenytoin,
carbamazepine, and
St John’s wort)
With liver cirrhosis
Warnings and Precautions
Ranexa blocks lKr and prolongs the
QTc interval in a dose-related
manner.
Clinical experience in an acute
coronary syndrome population
did not show an increased risk of
proarrhythmia or sudden death.
However, there is little experience
with high doses (> 1000 mg twice
daily) or exposure, with other QTprolonging drugs, with potassium
channel variants resulting in a
long QT interval, in patients with
a family history of (or congenital)
long QT syndrome, or in patients
with known acquired QT interval
prolongation.
Acute renal failure has been
observed in patients with severe
renal impairment while on
Ranexa. Monitor renal function
after initiation and periodically in
patients with moderate to severe
renal impairment. Discontinue
Ranexa if acute renal failure
develops.
Adverse Reactions
The most common adverse
reactions (> 4% and more
common than with placebo) during
treatment with Ranexa were
dizziness, headache, constipation,
and nausea.