Hospital Financial Structure and Unplanned Rehospitalization Following Acute Myocardial Infarction in the United States

BACKGROUND: Acute myocardial infarction (AMI) affects ∼805,000 individuals in the United States annually and remains a leading cause of rehospitalization. The Hospital Readmissions Reduction Program established 30-day readmissions as a quality benchmark for AMI care. Although for-profit hospitals have shown higher readmission rates than not-for-profit counterparts, ownership-related trends in readmissions and outcomes following AMI remain poorly characterized. OBJECTIVES: We examined 30-day nonelective readmission rates and clinical outcomes in readmitted AMI patients stratified by hospital ownership from 2013 to 2022. METHODS: Adult nonelective AMI hospitalizations were identified from the 2013 to 2022 Nationwide Readmissions Database and stratified by hospital ownership. Temporal trends were assessed with Cuzick nonparametric test. Among readmitted patients, outcomes were compared using doubly robust methodology. RESULTS: Of the 4,636,970 AMI admissions, 534,576 (11.5%) had an unplanned 30-day readmission. Of the 399,800 patients readmitted to the index hospital, 66,394 (16.6%) were treated at for-profit facilities. Over the study period, readmission rates declined at not-for-profit hospitals (11.5% to 10.5%; P < 0.001) but remained stable at for-profit hospitals (13.0% to 12.7%; P = 0.09). Rate reductions at for-profit hospitals were limited to Medicare beneficiaries and coronary artery bypass grafting patients. Following risk adjustment, for-profit status was independently associated with greater odds of 30-day nonelective readmission (adjusted OR [AOR]: 1.15), respiratory (AOR 1.11) and renal complications (AOR 1.04) at readmission, and nonhome discharge (AOR: 1.07). CONCLUSIONS: For-profit status was associated with higher 30-day nonelective readmission rates and greater odds of renal and respiratory complications at readmission and nonhome discharge. These findings may inform policies addressing ownership-related disparities in AMI care.