Factors influencing readmission among Thais with myocardial infarction

Rapin Polsook, Yupin Aungsuroch

DOI: https://doi.org/10.33546/bnj.1234


Background: Readmission among patients with myocardial infarction is costly, and it has become a marker of quality of care. Therefore, factors related to readmission warrant examination.

Objective: This study aimed at examining factors influencing readmission in Thai with myocardial infarction.

Methods: This was a cross-sectional study with 200 participants randomly selected from five regional hospitals in Thailand. All research tools used indicated acceptable validity and reliability. Linear Structural Relationship version 8.72 was used for the data analysis.

Results: The findings showed that the hypothesized model with social support, depression, symptom severity, comorbidity, and quality of life could explain 4% (R2 = 0.04) of the variance in readmission (c2 = 1.39, df = 2, p < 0.50, c2/df = 0.69, GIF = 1.00, RMSEA = 0.00, SRMR = 0.01, and AGFI = 0.98). Symptom severity was the most influential factor that had a positive and direct effect on the readmission rate (0.06, p < 0.05).

Conclusions: These findings serve as an input to decrease readmission in patients with myocardial infarction by reducing the symptom severity and comorbidity and promoting a better quality of life.

Funding: The Ratchadaphiseksomphot Endowment Fund, Chulalongkorn University, Bangkok, Thailand (CU-GR_60_38_36_03).


myocardial infarction; patient readmission; Thailand; nursing

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Adebayo, S. O., Olunuga, T. O., Durodola, A., & Ogah, O. S. (2017). Quality of life in heart failure: A review. Nigerian Journal of Cardiology, 14(1), 1-8. https://doi.org/10.4103/0189-7969.201914

Andrés, E., Cordero, A., Magán, P., Alegría, E., León, M., Luengo, E., . . . Casasnovas, J. A. (2012). Long-term mortality and hospital readmission after acute myocardial infarction: An eight-year follow-up study. Revista Española de Cardiología (English Edition), 65(5), 414-420. https://doi.org/10.1016/j.rec.2011.09.012

Annema, C., Luttik, M.-L., & Jaarsma, T. (2009). Reasons for readmission in heart failure: Perspectives of patients, caregivers, cardiologists, and heart failure nurses. Heart & Lung, 38(5), 427-434. https://doi.org/10.1016/j.hrtlng.2008.12.002

Bahall, M., & Khan, K. (2018). Quality of life of patients with first-time AMI: A descriptive study. Health and Quality of Life Outcomes, 16(1), 1-10. https://doi.org/10.1186/s12955-018-0860-8

Benbassat, J., & Taragin, M. (2000). Hospital readmissions as a measure of quality of health care: Advantages and limitations. Archives of Internal Medicine, 160(8), 1074-1081. https://doi.org/10.1001/archinte.160.8.1074

Bennett, S. J., Perkins, S. M., Lane, K. A., Deer, M., Brater, D. C., & Murray, M. D. (2001). Social support and health-related quality of life in chronic heart failure patients. Quality of Life Research, 10(8), 671-682. https://doi.org/10.1023/A:1013815825500

Burns, N., & Grove, S. (2005). The practice of nursing research conduct, critique and utilization. Missouri: Elsevier Saunders.

Charupronprasit, R., Sirirat., B., & Sumtip, J. (2017). Statistical Thailand; Morbidity rate of vaccine-preventable diseases per 100,000 populations, 2011-2016. Nonthaburi: Strategy and Planning Division Ministry of Public Health

Coffey, R. M., Misra, A., Barrett, M., Andrews, R. M., Mutter, R., & Moy, E. (2012). Congestive heart failure: Who is likely to be readmitted? Medical Care Research and Review, 69(5), 602-616. https://doi.org/10.1177/1077558712448467

Compare, A., Zarbo, C., Manzoni, G. M., Castelnuovo, G., Baldassari, E., Bonardi, A., . . . Romagnoni, C. (2013). Social support, depression, and heart disease: A ten year literature review. Frontiers in Psychology, 4, 384. https://doi.org/10.3389/fpsyg.2013.00384

Desta, L., Jernberg, T., Spaak, J., Hofman-Bang, C., & Persson, H. (2017). Risk and predictors of readmission for heart failure following a myocardial infarction between 2004 and 2013: A Swedish nationwide observational study. International Journal of Cardiology, 248, 221-226. https://doi.org/10.1016/j.ijcard.2017.05.086

Duffy, J. R. (2009). Quality caring in nursing: Applying theory to clinical practice, education, and leadership. New York: Springer Publishing Company.

Dunlay, S. M., Weston, S. A., Killian, J. M., Bell, M. R., Jaffe, A. S., & Roger, V. L. (2012). Thirty day hospital readmissions following acute myocardial infarction: A community study. Annals of Internal Medicine, 157(1), 11-18. https://doi.org/10.7326/0003-4819-157-1-201207030-00004

Edmondson, D., Green, P., Ye, S., Halazun, H. J., & Davidson, K. W. (2014). Psychological stress and 30-day all-cause hospital readmission in acute coronary syndrome patients: An observational cohort study. PloS One, 9(3), e91477. https://doi.org/10.1371/journal.pone.0091477

Faller, H., Steinbüchel, T., Störk, S., Schowalter, M., Ertl, G., & Angermann, C. E. (2010). Impact of depression on quality of life assessment in heart failure. International Journal of Cardiology, 142(2), 133-137. https://doi.org/10.1016/j.ijcard.2008.12.093

Fanari, Z., Elliott, D., Russo, C. A., Kolm, P., & Weintraub, W. S. (2017). Predicting readmission risk following percutaneous coronary intervention at the time of admission. Cardiovascular Revascularization Medicine, 18(2), 100-104. https://doi.org/10.1016/j.carrev.2016.12.003

Giamouzis, G., Kalogeropoulos, A., Georgiopoulou, V., Laskar, S., Smith, A. L., Dunbar, S., . . . Butler, J. (2011). Hospitalization epidemic in patients with heart failure: Risk factors, risk prediction, knowledge gaps, and future directions. Journal of Cardiac Failure, 17(1), 54-75. https://doi.org/10.1016/j.cardfail.2010.08.010

Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2010). Multivariate data analysis (7th ed.). Upper Saddle River, New Jersey: Pearson Education.

Hare, D. L., & Davis, C. R. (1996). Cardiac Depression Scale: Validation of a new depression scale for cardiac patients. Journal of Psychosomatic Research, 40(4), 379-386. https://doi.org/10.1016/0022-3999(95)00612-5

Hasan, O., Meltzer, D. O., Shaykevich, S. A., Bell, C. M., Kaboli, P. J., Auerbach, A. D., . . . Schnipper, J. L. (2010). Hospital readmission in general medicine patients: A prediction model. Journal of General Internal Medicine, 25(3), 211-219. https://doi.org/10.1007/s11606-009-1196-1

Heo, S., Lennie, T. A., Okoli, C., & Moser, D. K. (2009). Quality of life in patients with heart failure: Ask the patients. Heart & Lung, 38(2), 100-108. https://doi.org/10.1016/j.hrtlng.2008.04.002

Jencks, S. F., Williams, M. V., & Coleman, E. A. (2009). Rehospitalizations among patients in the Medicare fee-for-service program. New England Journal of Medicine, 360(14), 1418-1428. https://doi.org/10.1016/j.jvs.2009.05.045

Jenghua, K., & Jedsadayanmata, A. (2011). Rate and predictors of early readmission among Thai patients with heart failure. Journal of the Medical Association of Thailand [Chotmaihet thangphaet], 94(7), 782-788.

Kang, K., Gholizadeh, L., Han, H.-R., & Inglis, S. C. (2018). Predictors of health-related quality of life in korean patients with myocardial infarction: A longitudinal observational study. Heart & Lung, 47(2), 142-148. https://doi.org/10.1016/j.hrtlng.2017.12.005

Kansagara, D., Englander, H., Salanitro, A., Kagen, D., Theobald, C., Freeman, M., & Kripalani, S. (2011). Risk prediction models for hospital readmission: A systematic review. JAMA, 306(15), 1688-1698. https://doi.org/10.1001/jama.2011.1515

Kiropoulos, L. A., Meredith, I., Tonkin, A., Clarke, D., Antonis, P., & Plunkett, J. (2012). Psychometric properties of the cardiac depression scale in patients with coronary heart disease. BMC Psychiatry, 12(1), 216. https://doi.org/10.1186/1471-244x-12-216

Kwok, C. S., Rao, S. V., Potts, J. E., Kontopantelis, E., Rashid, M., Kinnaird, T., . . . Mamas, M. A. (2018). Burden of 30-day readmissions after percutaneous coronary intervention in 833,344 patients in the United States: Predictors, causes, and cost: Insights from the Nationwide Readmission Database. JACC: Cardiovascular Interventions, 11(7), 665-674. https://doi.org/10.1016/j.jcin.2018.01.248

Kwok, C. S., Wong, C. W., Shufflebotham, H., Brindley, L., Fatima, T., Shufflebotham, A., . . . Mamas, M. A. (2017). Early readmissions after acute myocardial infarction. The American Journal of Cardiology, 120(5), 723-728. https://doi.org/10.1016/j.amjcard.2017.05.049

Lawson, C. A., Solis-Trapala, I., Dahlstrom, U., Mamas, M., Jaarsma, T., Kadam, U. T., & Stromberg, A. (2018). Comorbidity health pathways in heart failure patients: A sequences-of-regressions analysis using cross-sectional data from 10,575 patients in the Swedish Heart Failure Registry. PLoS medicine, 15(3), e1002540. https://doi.org/10.1371/journal.pmed.1002540

Leifheit-Limson, E. C., Reid, K. J., Kasl, S. V., Lin, H., Buchanan, D. M., Jones, P. G., . . . Lichtman, J. H. (2012). Changes in social support within the early recovery period and outcomes after acute myocardial infarction. Journal of Psychosomatic Research, 73(1), 35-41. https://doi.org/10.1016/j.jpsychores.2012.04.006

Liu, R. T., Hernandez, E. M., Trout, Z. M., Kleiman, E. M., & Bozzay, M. L. (2017). Depression, social support, and long-term risk for coronary heart disease in a 13-year longitudinal epidemiological study. Psychiatry Research, 251, 36-40. https://doi.org/10.1016/j.psychres.2017.02.010

Martínez-García, M., Vargas-Barrón, J., Bañuelos-Téllez, F., González-Pacheco, H., Fresno, C., Hernández-Lemus, E., . . . Vallejo, M. (2018). Public insurance program impact on catastrophic health expenditure on acute myocardial infarction. Public Health, 158, 47-54. https://doi.org/10.1016/j.puhe.2018.01.025

McGowan, L., Dickens, C., Percival, C., Douglas, J., Tomenson, B., & Creed, F. (2004). The relationship between vital exhaustion, depression and comorbid illnesses in patients following first myocardial infarction. Journal of Psychosomatic Research, 57(2), 183-188. https://doi.org/10.1016/S0022-3999(03)00610-X

McNeely, C., Markwell, S., & Vassileva, C. M. (2016). Readmission after inpatient percutaneous coronary intervention in the Medicare population from 2000 to 2012. American Heart Journal, 179, 195-203. https://doi.org/10.1016/j.ahj.2016.07.002

Nuraeni, A., Mirwanti, R., & Anna, A. (2019). Effect of a workbook in health education on self-efficacy and quality of life of patients with coronary heart disease. Belitung Nursing Journal, 5(6), 218-224. https://doi.org/10.33546/bnj.801

O'Brien, C., Valsdottir, L., Wasfy, J. H., Strom, J. B., Secemsky, E. A., Wang, Y., & Yeh, R. W. (2017). Comparison of 30-day readmission rates after hospitalization for acute myocardial infarction in men versus women. The American Journal of Cardiology, 120(7), 1070-1076. https://doi.org/10.1016/j.amjcard.2017.06.046

O'Loughlin, C., Murphy, N. F., Conlon, C., O'Donovan, A., Ledwidge, M., & McDonald, K. (2010). Quality of life predicts outcome in a heart failure disease management program. International Journal of Cardiology, 139(1), 60-67. https://doi.org/10.1016/j.ijcard.2008.09.003

Oldridge, N. B. (1997). Outcome assessment in cardiac rehabilitation: Health-related quality of life and economic evaluation. Journal of Cardiopulmonary Rehabilitation and Prevention, 17(3), 179-194. https://doi.org/10.1097/00008483-199705000-00005

Phromsornt, W., Aungsuroch, Y., & Polsook, R. (2019). Factor predicting depression among post-acute myocardial infarction patients. Royal Thai Navy Medical Journal, 46(3), 592-606.

Polsook, R., & Aungsuroch, Y. (2019). Validity and reliability of the Thai version of the Cardiac Depression Scale among Thai cardiac patients. Songklanakarin Journal of Science & Technology, 41(3), 658-663.

Polsook, R., & Aungsuroch, Y. (2020). A cross-sectional study of factors predicting readmission in Thais with coronary artery disease. Journal of Research in Nursing, 1744987120946792. https://doi.org/10.1177/1744987120946792

Polsook, R., Aungsuroch, Y., & Thanasilp, S. (2013). Factors predicting medication adherence among Thai post myocardial infarction patients. Journal of Health Research, 27(4), 211-216.

Polsook, R., Aungsuroch, Y., & Thanasilp, S. (2016). Medication adherence among persons with post-acute myocardial infarction. Songklanakarin Journal of Science & Technology, 38(6), 611-620.

Ryan, J., Andrews, R., Barry, M. B., Kang, S., Iskandar, A., Mehla, P., & Ganeshan, R. (2014). Preventability of 30-day readmissions for heart failure patients before and after a quality improvement initiative. American Journal of Medical Quality, 29(3), 220-226. https://doi.org/10.1177/1062860613496135

Saengsiri, A.-o., & Hacker, E. D. (2015). Conducting quality of life research in people with coronary artery disease in non–english-speaking countries: Conceptual and operationalization issues. Journal of Cardiovascular Nursing, 30(1), 74-84. https://doi.org/10.1097/JCN.0000000000000116

Sangareddi, V., Chockalingam, A., Gnanavelu, G., Subramaniam, T., Jagannathan, V., & Elangovan, S. (2004). Canadian Cardiovascular Society classification of effort angina: An angiographic correlation. Coronary Artery Disease, 15(2), 111-114. https://doi.org/10.1097/00019501-200403000-00007

Sethares, K. A., & Elliott, K. (2004). The effect of a tailored message intervention on heart failure readmission rates, quality of life, and benefit and barrier beliefs in persons with heart failure. Heart & Lung, 33(4), 249-260. https://doi.org/10.1016/j.hrtlng.2004.03.005

Southern, D. A., Ngo, J., Martin, B. J., Galbraith, P. D., Knudtson, M. L., Ghali, W. A., . . . Wilton, S. B. (2014). Characterizing types of readmission after acute coronary syndrome hospitalization: Implications for quality reporting. Journal of the American Heart Association, 3(5), e001046. https://doi.org/10.1161/jaha.114.001046

Tully, P. J., Baumeister, H., Bennetts, J. S., Rice, G. D., & Baker, R. A. (2016). Depression screening after cardiac surgery: A six month longitudinal follow up for cardiac events, hospital readmissions, quality of life and mental health. International Journal of Cardiology, 206, 44-50. https://doi.org/10.1016/j.ijcard.2016.01.015

Volz, A., Schmid, J.-P., Zwahlen, M., Kohls, S., Saner, H., & Barth, J. (2011). Predictors of readmission and health related quality of life in patients with chronic heart failure: A comparison of different psychosocial aspects. Journal of Behavioral Medicine, 34(1), 13-22. https://doi.org/10.1007/s10865-010-9282-8

Wongpakaran, N., & Wongpakaran, T. (2012). A revised thai multi-dimensional scale of perceived social support. Spanish Journal of Psychology, 15(3), 1503-1509. https://doi.org/10.5209/rev_sjop.2012.v15.n3.39434

Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52(1), 30-41. https://doi.org/10.1207/s15327752jpa5201_2


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