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 Table 2 – Clinical conditions associated with readmissions in patients with acute coronary syndrome in Aracaju, Brazil, 2017 Variable Readmission p value* Yes No Type of ACS Unstable angina 20 (20.83%) 76 (79.17%) 0.0205 NSTEMI 56 (27.45%) 148 (72.55%) STEMI 39 (16.53%) 197 (83.47%) Arterial hypertension 97 (22.99%) 325 (77.01%) 0.1255 Dyslipidemias 81 (27.93%) 209 (72.07%) 0.0001 Diabetes mellitus 48 (25.81%) 138 (74.19%) 0.0933 Previous CAD 59 (30.73%) 133 (69.27%) 0.0001 Congestive heart failure 39 (31.45%) 85 (68.55%) 0.0030 Angina 66 (25.38%) 194 (74.62%) 0.0408 Previous AMI 58 (30.53%) 132 (69.47%) 0.0002 Previous angioplasty 31 (32.29%) 65 (67.71%) 0.0066 Previous myocardial revascularization 12 (31.58%) 26 (68.42%) 0.1700 Previous chronic kidney disease 18 (51.43%) 17 (48.57%) < 0.0001 *ACS: acute coronary syndrome; NSTEMI: acute myocardial infarction without ST-segment elevation (NSTEMI); STEMI: acute myocardial infarction with ST-segment elevation (STEMI); AMI: acute myocardial infarction; CAD: coronary artery disease; Chi-square test. Table 3 – Drug therapy associated with readmissions in patients with acute coronary syndrome in Aracaju, Brazil, 2017 Variable Readmission p value* Yes No Without ASA for 30 days 3 (15.8%) 16 (84.2%) 1.0000 Without antiplatelet agents for 30 days 9 (30.0%) 21 (70%) 0.2111 Without statin for 30 days 6 (11.5%) 46 (88.5%) 0.2037 Without β-blockers for 30 days 12 (35.3%) 22 (64.7%) 0.0507 Without ACEI and/or ARBs for 30 days 6 (15.0%) 34 (85.0%) 0.4259 Without ASA for 180 days 5 (14.3%) 30 (85.7%) 0.4566 Without antiplatelet agents for 180 days 9 (16.4%) 46 (83.6%) 0.5640 Without statin for 180 days 8 (10.3%) 70 (89.7%) 0.0293 Without β-blockers for 180 days 12 (24.5%) 37 (75.5%) 0.6863 Without ACEI and/or ARBs for 180 days 16 (24.6%) 49 (75.4%) 0.5628 * acetylsalicylic acid (ASA); ACEI: angiotensin-converting enzyme inhibitors; ARBs: angiotensin receptor blockers; chi-square test or Fisher’s exact test The presence of other risk factors, particularly concomitant ones, increases the odds of readmission. 23 The occurrence of comorbidities associated with ACS affects disease severity, and increases the need for invasive interventions. A study conducted by Belitardo & Ayoub, 1 that evaluated readmission in elderly patients, reported that SAH, sedentary lifestyle, dyslipidemia, DM, stress, smoking and obesity increased the odds of requiring invasive procedures and readmissions. Patient destination after discharge, which is related to disease severity, is also associated with 30-day readmission in patients with congestive heart failure, as discussed in the study by Mirkin et al. 24 Patients had different destinations after discharge, and those requiring specialized support services had higher readmission rates. The diversity of causes of readmission reinforces the importance of the access to regional health services and the degree of coverage of health services to reduce risk factors and complications that may affect readmission outcomes. 25 Therefore, strategies aimed at reducing the occurrence of readmission should include planning of discharge, promotion of health education of patients and family members, scheduling of patients’ follow-up before and after discharge, appropriate use of medications, effective communication 46