Non-specific pain and 30-day readmission in acute coronary syndromes: findings from the TRACE-CORE prospective cohort

• Published in: BMC cardiovascular disorders Vol. 21; no. 1; pp. 383 - 11
• Main Authors: Chen, Jinying, Kiefe, Catarina I., Gagnier, Marc, Lessard, Darleen, McManus, David, Wang, Bo, Houston, Thomas K.
• Format: Journal Article
• Language: English
• Published: London BioMed Central 09.08.2021; BioMed Central Ltd; BMC
• Subjects: Acute coronary syndrome; Acute Coronary Syndrome - complications; Acute Coronary Syndrome - ethnology; Acute coronary syndromes; Admission and discharge; Aftercare; Aged; Angina; Angina pectoris; Angiology; Blood Transfusion Medicine; Cardiac catheterization; Cardiac Surgery; Cardiology; Cardiovascular disease; Care and treatment; Care transition; Chest; Chest Pain - etiology; Demographic aspects; Diagnosis; Documentation; Electronic Health Records; Electronic medical records; Emergency medical care; Female; Health services; Heart; Hospitalization; Hospitals; Human subjects; Humans; Identification and classification; Internal Medicine; Intubation; Ischemia; Logistic Models; Male; Medical records; Medicine; Medicine & Public Health; Middle Aged; Non-specific pain; Odds Ratio; Pain; Patient Discharge; Patient outcomes; Patient Readmission - statistics & numerical data; Patients; Prospective Studies; Readmission; Subject specialists; United States; Care transition; Cardiovascular disease; Readmission; Natural language processing; Acute coronary syndrome; Non-specific pain; Electronic health records
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-021-02195-z

Background Patients with acute coronary syndromes often experience non-specific (generic) pain after hospital discharge. However, evidence about the association between post-discharge non-specific pain and rehospitalization remains limited. Methods We analyzed data from the Transitions, Risks, and Actions in Coronary Events Center for Outcomes Research and Education (TRACE-CORE) prospective cohort. TRACE-CORE followed patients with acute coronary syndromes for 24 months post-discharge from the index hospitalization, collected patient-reported generic pain (using SF-36) and chest pain (using the Seattle Angina Questionnaire) and rehospitalization events. We assessed the association between generic pain and 30-day rehospitalization using multivariable logistic regression (N = 787). We also examined the associations among patient-reported pain, pain documentation identified by natural language processing (NLP) from electronic health record (EHR) notes, and the outcome. Results Patients were 62 years old (SD = 11.4), with 5.1% Black or Hispanic individuals and 29.9% women. Within 30 days post-discharge, 87 (11.1%) patients were re-hospitalized. Patient-reported mild-to-moderate pain, without EHR documentation, was associated with 30-day rehospitalization (odds ratio [OR]: 2.03, 95% confidence interval [CI]: 1.14–3.62, reference: no pain) after adjusting for baseline characteristics; while patient-reported mild-to-moderate pain with EHR documentation (presumably addressed) was not (OR: 1.23, 95% CI: 0.52–2.90). Severe pain was also associated with 30-day rehospitalization (OR: 3.16, 95% CI: 1.32–7.54), even after further adjusting for chest pain (OR: 2.59, 95% CI: 1.06–6.35). Conclusions Patient-reported post-discharge generic pain was positively associated with 30-day rehospitalization. Future studies should further disentangle the impact of cardiac and non-cardiac pain on rehospitalization and develop strategies to support the timely management of post-discharge pain by healthcare providers.