ABC | Volume 113, Nº1, July 2019

Original Article Readmission of Patients with Acute Coronary Syndrome and Determinants Larissa Marina Santana Mendonça de Oliveira, 1 Ingrid Maria Novais Barros de Carvalho Costa, 1,2 Danielle Góes da Silva, 3 José Rodrigo Santos Santos Silva, 4 J osé Augusto Soares Barreto-Filho, 1,5,6 Marcos Antônio Almeida‑Santos, 7 Joselina Luzia Meneses Oliveira, 1,5 Mirella Dornelas Batalha Moreira Buarque, 8,9 Diva Aliete dos Santos Vieira, 10 Antônio Carlos Sobral Sousa 1,5,6 Universidade Federal de Sergipe - Departamento de Pós-Graduação em Ciências da Saúde, 1 São Cristovão, SE – Brazil Instituto Federal de Educação Ciência e Tecnologia de Sergipe, 2 São Cristovão, SE – Brazil Universidade Federal de Sergipe - Departamento de Nutrição, 3 São Cristovão, SE – Brazil Universidade Federal de Sergipe - Departamento de Estatística, 4 São Cristovão, SE – Brazil Universidade Federal de Sergipe - Departamento de Medicina, 5 São Cristovão, SE – Brazil Fundação São Lucas - Centro de Ensino e Pesquisa, 6 Aracaju, SE – Brazil Programa de Pós-graduação em Saúde e Ambiente da Universidade Tiradentes, 7 Aracaju, SE – Brazil Hospital do Coração, 8 Aracaju, SE – Brazil Fundação de Beneficência do Hospital Cirurgia, 9 Aracaju, SE – Brazil Universidade Federal de Sergipe - Departamento de Nutrição, 10 Lagarto, SE – Brazil Mailing Address: Larissa Marina Santana Mendonça de Oliveira • Universidade Federal de Sergipe - R. Cláudio Batista, s/n - Palestina, Postal Code 49060-108, Aracaju, SE – Brasil, Aracaju, SE – Brazil E-mail: nutrilarissamarina@gmail.com Manuscript received August 09, 2018, revised manuscript October 23, 2018, accepted November 01, 2018 DOI: 10.5935/abc.20190104 Abstract Background: Acute coronary syndrome (ACS) is responsible for high rates of hospital admission and readmission, which are associated with increased costs for the patient and the health system, and increased in-hospital mortality rates. Objective: To evaluate readmission in patients with ACS and its determinants. Methods: This was a retrospective cohort study of adult and elderly patients with ACS, readmitted to public and private referral cardiology hospitals within one year after the first hospitalization for ACS. The occurrence of readmissions, the time elapsed from the first to the second admission, and the use of medications at admission were collected from the medical records. Associations between categorical variables were evaluated by the chi-square test or the Fisher’s exact test. Multiple logistic regression was used to evaluate predictors for readmissions. A p < 0.05 was set as statistically significant. Results: Readmission rate was 21.5% (n = 115) and mean time between admissions was 122.7 ± 112.1 days. The patients were mostly men (64.0%), mean age of 63.15 ± 12.3 years. Among readmitted patients, 7% had a prognosis of “death”, and 68.7% were readmitted more than once within a one-year period. The main reasons of readmission were cardiovascular diseases including ACS. Private health care and the diagnosis of congestive heart failure were associated with multiple logistic regression. Conclusion: ACS was the main cause of readmission, with higher prevalence among users of supplemental health care. Readmissions were associated with previous diagnosis of congestive heart failure and the type of health care provided. (Arq Bras Cardiol. 2019; 113(1):42-49) Keywords: Acute Coronary Syndrome; Hospitalization/economy; Patient Readmission/economy; Heart Failure; Delivery of Health Care/economy; Hospital Mortality; Socioeconomic Factors; Drug Therapy/economia. Introduction During the last years, there has been increasing rates of hospital admission and readmission for ischemic heart diseases, including acute coronary syndrome (ACS). 1 Hospital readmissions account for a significant increase in costs for the patient and public and private health system, and in hospital mortality. The risk of death in readmitted patients is greater when readmissions occur for cardiac causes. 2-4 After an ACS event, hospital readmissions may be associated with different cardiac conditions, including myocardial ischemia, arterial fibrillation and uncontrolled hypertension, and also non-cardiac conditions such as poor treatment adherence, alcohol consumption, psychological factors, socioeconomical factors and health system issues. 5-7 Besides, hospital readmissions are correlated with the quality of the health care provided and management of comorbidities during hospitalization, and hence may be used as quality indicators of the healthcare services. 8,9 The type of health care system can also influence readmission rates, as it reflects different levels of access to health care and inequality between individuals. 8 42