Annals of Internal Medicine tip sheet for July 3, 2012, issue

Each year nearly 785,000 people are hospitalized for a first heart attack. Treatment advances have contributed to improved survival rates, but rehospitalization in the first 30 days after discharge remains a common and costly problem. Researchers studied 3,010 patients in one health system who were hospitalized with a first-time heart attack between 1987 and 2010 to determine the rate of rehospitalization, the reasons for rehospitalization, and the factors that increased rehospitalization. The researchers found that about 40 percent of 30-day rehospitalizations were due to the heart attack, while the remaining cases were due to other causes. Comorbid conditions such as diabetes, COPD, anemia, and higher Killip class (a risk stratification method for heart attack patients) were associated with higher rates of rehospitalization. Longer initial hospital stays and complications due to common treatments such as angiography, reperfusion, or revascularization were also associated with an increased risk for rehospitalization. The researchers conclude that recognizing and addressing the factors that contribute to rehospitalization may help to improve patient outcomes.

Many heart patients make mistakes with their medications after hospital discharge that could lead to clinically important adverse outcomes. Patients who are most vulnerable are the elderly, those with impaired cognitive function or low health literacy, or patients who are prescribed numerous or high-risk medications. These outcomes could be prevented, or their severity could be reduced with appropriate interventions. Researchers randomly assigned 831 adults hospitalized for acute coronary syndromes or acute decompensated heart failure to either usual care or usual care plus a pharmacist intervention (check of medication accuracy, in-patient counseling, patient-education materials, telephone follow-up). In the 30 days following hospitalization, one half of the patients had a clinically important medication error, regardless of whether they were in the usual care or pharmacist intervention group. The researchers conclude that more work is needed to help prevent medication errors in cardiac patients.