Myocardial Infarction: Reducing Hospital Readmission Rates

Introduction: Post-Angioplasty Complications and Patient Education

Donald, an acute myocardial infarction (MI) patient, has undergone angioplasty, a procedure in which a catheter is inserted into clogged arteries in a patient's heart to widen them and improve blood flow. To supplement the angioplasty, Donald has had cardiac stents placed to prop the affected arteries open and reduce their risk of narrowing again. Studies have shown that several complications could result from angioplasty procedures and the insertion of stents. The most common complications include bleeding or vascular complications (6 percent of patients), acute renal failure (5 percent of patients), and stroke (0.3 percent of patients) (Dunlay et al., 2012).

A study analyzing readmission rates among MI patients in Minnesota found that bleeding was the most common complication after angioplasty, affecting 6 percent of patients (Dunlay et al., 2012). The most common form of bleeding was bleeding at the catheter access site, which affected 62.7 percent of patients. An additional 37.4 percent of patients reported complications associated with groin hematoma, gastrointestinal bleeding, and bleeding from other sites (Dunlay et al., 2012). At times the bleeding is no more than a bruise, but in other cases it may be serious enough to require surgical procedures or a blood transfusion.

To minimize the risk of side effects related to cardiac catheterization, the nurse plans to educate the patient on the potential side effects and what steps can be taken to reduce their likelihood. This includes providing information sheets explaining the symptoms of retroperitoneal bleeding and hematoma formation at the groin site, as well as methods of preventing both conditions (Dunlay et al., 2012). The nurse will also distribute simplified information sheets teaching the patient how to self-hydrate as a way to minimize the risk of renal failure resulting from cardiac catheterization (Lambert et al., 2017). Since the patient's extended family lives nearby, it is practical to include them in this awareness-raising effort to ensure they can adequately distinguish between normal and abnormal signs. It is also prudent for the nurse to connect the patient with their primary care provider to facilitate ongoing monitoring of side effects upon discharge (Lambert et al., 2017). Studies have shown that patient education has significant benefits in reducing the risk of renal complications after angioplasty by as much as 20 percent (Lambert et al., 2017).

References

Borghi, C., & Ambrosioni, E. (1996). Primary and secondary prevention of myocardial infarction. Clinical and Experimental Hypertension, 18(3), 547–58.

CMS (n.d.). Guide to reducing disparities in readmissions. Center for Medicare and Medicaid. Retrieved from https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/OMH_Readmissions_Guide.pdf

Dunlay, S., Weston, S. A., Killian, J., Bell, R. M., Jaffe, A. S., & Roger, V. L. (2012). Thirty-day hospital readmissions following acute myocardial infarction: A community study. Annals of Internal Medicine, 157(1), 11–18.

Jones, R., Arps, K., Davis, D. M., Blumenthal, R. S., & Martin, S. S. (2018). Clinician guide to the ABCs of primary and secondary prevention of atherosclerotic cardiovascular disease. American College of Cardiology. Retrieved from

Karunathilake, S. P., & Ganegoda, G. (2018). Secondary prevention of cardiovascular diseases and application of technology for early diagnosis. BioMed Research International. doi: 10.1155/2018/5767864

Lambert, P., Chaisson, K., Horton, S., Petrin, C., & Brown, J. (2017). Reducing contrast-induced acute kidney injury: How nurses can improve patient safety, a qualitative investigation. Critical Care Nursing, 37(1), 13–26.