Background:

different research has shown that secondary prevention in coronary artery disease patients may beneficially influence on cardiovascular morbidity and mortality. Diverse studies report different results, varying over a wide range according to the objectives and there are no data about our environment. At our institution, a secondary prevention program that includes all patients admitted for a coronary disease takes place.

Purpose:

to determine the rehospitalization and post-hospital mortality rates in patients with coronary disease participating in a secondary prevention program and to explore their causes.

Methods:

an observational and prospective study about the incidence of hospital readmissions and deaths in a cohort of post-hospital coronary patients was performed by analyzing the computerized clinical history and telephone follow-up of all patients, which was performed for a mean time of 4.8 years. Their causes were established, and processed data are expressed as percentages, while the rate differences were analyzed using the chi test or t test as appropriate.

Results:

one thousand three hundred and seventy-five consecutive ischemic heart disease patients were included, age 68.1 ± 10.0 years (37-80), 72.5% male. Acute coronary syndrome was the cause of hospitalization in 71.0% of cases. The follow-up of 74 patients was lost. Of the remaining 1.301 patients, at the end of the follow-up period, 616 (47.3%) patients were readmitted. There were 1.226 new hospital readmissions, due to a new coronary episode in 361 (29.4%) of which 144 (39.9%) received a new coronary transluminal angioplasty and 62 (17.2%) myocardial revascularization surgery (p> 0.001). The highlight was that 79.2% of the total number of patients was free of new coronary events throughout the whole period and coronary readmissions were very scarce in the first year after hospital discharge (2.8%). Regarding the deaths, there were 107 (7.8% of 1.371 patients with available mortality data), of which 74 were cardiovascular origin (5.4%) and the majority, 45 (60.8%) occurred within the first year (p<0.001 vs. death >1 year). Sudden death (26.2%), acute myocardial infarction (22.4%) and heart failure (13.1%) were predominant causes.

Conclusions:

in this consecutive and unselected series of patients hospitalized for coronary disease included in a secondary prevention program, readmission rates were similar to those published and mortality was among the lowest reported in the literature. Most readmissions and deaths occurred due to an ischemic event, and the mortality rate due to heart failure was low. It is possible that the cardiovascular prevention program has had an impact on the observed results.

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