Home‐Time After Discharge Among Patients With Type 2 Myocardial Infarction

Abstract

Background Home‐time, defined as the time spent alive outside of a healthcare institution, has emerged as a patient‐centered health outcome. The discharge locations and distribution of home‐time after a type 2 myocardial infarction are unknown. Methods and Results Patients with a type 2 myocardial infarction between October 2017 and May 2018 at Massachusetts General Hospital were included. Patients discharged to hospice or without follow‐up data were excluded. Our primary outcome was home‐time defined as the number of days lived outside of a hospital, long‐term acute care facility, skilled nursing facility, or rehabilitation facility. We identified 359 patients with type 2 myocardial infarction over the study period. Of those discharged alive (N=321), 62.9% were discharged home, and the remainder went to a facility or hospice. Among those with available follow‐up data (N=289), the median home‐time was 30 (interquartile range [IQR], 16–30) days at 30 days, 171 (IQR, 133–180) days at 180 days, and 347 (IQR, 203–362) days at 365 days. At 1 year, 29 patients (10%) with type 2 myocardial infarction had spent no time at home and only 57 patients (19.7%) spent the entire year alive and at home. At 1 year, postdischarge all‐cause mortality was 23.2%, all‐cause readmission was 69.2%, and major adverse cardiovascular events (composite of all‐cause mortality, recurrent myocardial infarction, or stroke) was 34.9%. Home‐time through 1 year correlated strongly with time‐to‐event all‐cause mortality (τ=0.54, P<0.001) and major adverse cardiovascular events (τ=0.52, P<0.001) and modestly with a composite of all‐cause mortality or readmission (τ=0.44, P<0.001). Conclusions Home‐time is low after a hospitalization for type 2 myocardial infarction and correlates strongly with mortality and major adverse cardiovascular events.

Keywords

• home‐time
• patient‐centered health outcome
• type 2 myocardial infarction