Fewer treatments, higher readmission rates: Tracking outcomes for homeless patients after heart attacks

Homeless patients receive fewer treatments and experience higher readmission rates when hospitalized for a heart attack than other patients, according to new findings published in Mayo Clinic Proceedings.

The researchers, including representatives from West Virginia University and Mayo Clinic, explored data from more than 1.1 million hospitalizations for acute myocardial infarction (AMI) from the National Readmission Database. All patients were treated in 2015-2016.

Overall, the team found that 0.4% of the patients they studied were homeless. These patients were younger than non-homeless patients, more likely to be men and had “a higher prevalence of congestive heart failure, anemia and chronic kidney, liver, and lung diseases.” Anxiety, depression, substance abuse and human immunodeficiency virus infections were also more common among the homeless patient cohort.

One of the authors’ most significant findings was that homeless patients were less likely to undergo coronary angiography (38.1% compared to 54%), percutaneous coronary intervention (24.1% compared to 38.7%) and coronary artery bypass grafting (4.9% compared to 6.7%). Homeless patients also had much higher readmission rates after 30 days (22.5% compared to 10%) and more readmissions due to psychiatric reasons (18% compared to 2%).

“Addressing cardiovascular disease in the growing population of the homeless comes with a unique set of challenges,” senior author Mohamad Alkhouli, MD, Mayo Clinic Alix School of Medicine, said in a prepared statement. “The high burden of psychiatric illness among the homeless emphasizes the need for a holistic approach to address both the clinical and social needs of these patients.”

The authors also wrote that these statistics show why “stakeholders need to collaborate on policies and interventions to improve the psychosocial profile, healthcare delivery and outcomes in homeless patients.”

Research published in JAMA Internal Medicine in November 2019 reached similar conclusions. More information on that study is available here.