Title: REadmissions, Adverse Complications and ouTcomes following Acute Myocardial Infarction (REACT-AMI) study
Funder: The Academy of Medical Sciences

Abstract: There is limited information around the incidence and type of post-discharge complications of AMI, unplanned readmission and their association with long term outcomes. We hypothesise that although the risk of mechanical complications following an AMI has reduced over time, there is an increased risk of ischemic and bleeding complications resulting in unplanned readmissions in this cohort due to changes in population demographics, evolving pharmacological and invasive treatments. By using a large scale, multisource longitudinal cohort of patients hospitalised with a diagnosis of AMI, this study aims to study various patient and hospital characteristics associated with unplanned readmissions. The main aims and objectives of this study are Aims: To determine the type, incidence, prevalence, secular trends and prognostic impact of post-discharge complications and unplanned 30-day readmissions on long term clinical outcomes in patients admitted with acute myocardial infarction (AMI). Objectives: •What are the rates of 30-day unplanned readmissions following an AMI? What proportion of these are due to complications or cardiovascular and non-cardiovascular causes? •Are there differences in the types, incidence and rates of unplanned readmissions between different phenotypes of AMI and what is their association with long term survival? •What are the baseline clinical characteristics, pharmacological factors, and treatment strategies associated with incident unplanned readmissions and complications at 30 days? •What are the geographical variations between different hospitals in the rates of complications and readmissions? Are there patient, treatment or institutional-level factors that contribute to such differences?

Lay abstract: This study is designed to study post-discharge complications, unplanned readmissions and their association with long term outcomes of the patient suffering from a heart attack in England and Wales. We are studying the frequency of different complications such as bleeding, repeat heart attack, stroke and other medical causes of unplanned readmissions in patients within 30 days of a heart attack. We also wish to examine institutional differences and different causes of readmissions between the hospitals and whether they can be explained by the differences between the hospitals, clinical characteristics or treatments given to the patients. This is particularly important as heart attack remains one of the commonest causes of death in the UK and worldwide. This will enable us to understand better the efficacy and safety of newer treatments of heart attacks, describe patterns of different complications related to these treatments and how they impact the patient’s outcomes. The institutional differences will be linked to quality improvement initiatives which will help to identify the areas of improvements in patient care and develop interventions to reduce the burden of unplanned readmissions. For this study, we will first identify all patients admitted with a heart attack in England and Wales from the national heart attack audit programme data. The records of these patients will be linked to hospital admission and death registration data in England and Wales. By linking these three datasets, we will be able to quantify the occurrence of common complications which may lead to unplanned readmission in this cohort.

Research activity codes: 2.1 BIOLOGICAL AND ENDOGENOUS FACTORS;2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: CARDIOVASCULAR