ABC | Volume 113, Nº1, July 2019

Original Article Oliveira et al Readmission of patients with coronary syndrome Arq Bras Cardiol. 2019; 113(1):42-49 Therefore, the present study aimed to evaluate readmission rates after an ACS event among users of a public, supplemental health care system in the state of Sergipe, Brazil, and to evaluate the association between readmission rate and socioeconomic determinants of lifestyle and clinical outcomes. Methods Study design This was a retrospective cohort study of patients with ACS, conducted between August 2017 and April 2018. A total of 581 patients was selected during the first admission (October 2013–September 2015) to one of the four referral hospitals in the city of Aracaju, Brazil. Three of these institutions provided private health services and one of them provided public services. All participants were evaluated at three time points throughout the study: at hospital admission, and 30 days and 180 days after the ACS event. 4 Clinical diagnosis of ACS at admission and the type of ACS – acute ischemia, acute myocardial infarction with ST‑segment elevation (STEMI), and acute myocardial infarction without ST-segment elevation (NSTEMI) – were collected from medical records. These diagnoses were made based on physician’s interpretation of symptoms (consistent with acute ischemia in the 24 hours prior to admission) and/or on elevation of biomarkers of cardiac ischemia, confirmed by electrocardiography, Doppler echocardiography or coronary cineangiography. Once personal data (name, date of birth, date of hospital admission) of patients were obtained, the medical records were searched for the occurrence of readmissions within one year after the first admission for ASC. Study sample One-year readmission after first hospitalization for ACS was investigated in a cohort of 581 patients with ACS (Figure 1). Inclusion criteria All patients admitted for ACS in cardiology referral hospitals in Aracaju, Sergipe, Brazil, identified at baseline of the study were included. Exclusion criteria Patients who died during or after discharge of the first hospitalization, patients who were not readmitted after discharge of the first admission, and those who were presented readmission with less than 24 hours of hospital stay. Outcome measures Socioeconomic status Patients’ personal data were retrieved from the database of first admitted ACS patients during the period from October 2013 to September 2015. 4 A semi-structured questionnaire was used at the time of admission for ACS. Data of age (adults and elderly patients), sex (female and male), self-referred race (white, pardo, black), educational attainment (more or less 9 years of schooling), per capita income (less than 1 salary/person, 1-3 salaries/person, 3-5 salaries/person andmore than 5 salaries/ person), type of health care (public or private), life habits – alcohol consumption and smoking, reported by the patient or caregiver, and physical activity (classified by the international physical activity questionnaire, IPAQ) – nutritional status according to the body mass index (BMI) and waist circumference (WC). BMI was classified into low weight, normal weight and overweight, according to the World Health Organization (WHO) 10 cut-off points (for adults) and the Pan American Health Organization (PAHO) 11 cut-off points (for older patients). A WC < 80 cm for women and < 94 cm for men was considered normal. 10 Hospital readmission Occurrence of readmissions within one year after discharge was searched in the medical records of four cardiology referral hospitals. Data regarding the cause and date of readmissions and use of medications at the time of readmission were collected. All this informationwas transferred into a structuredquestionnaire. Hospital admissions were categorized according to the primary diagnosis and the reason of admission – ACS, cardiovascular and noncardiovascular causes. Drug therapy After 30 and 180 days after discharge, the use, or not, of the following drugs was assessed: antiplatelet agents, statins, Figure 1 – Flow chart of the occurrence of readmission within one year after the first admission in patients with acute coronary syndrome. 581 patients 555 patients 26 patients excluded for in-hospital deaths 10 patients excluded for death after discharge without readmission 9 patients excluded after readmission with hospital stay of less than 24 hours 545 patients 536 patients 43