April 3, 2015 — Patients 65 or older discharged from the hospital as early as 48 hours after angioplasty following a major heart attack have similar outcomes as those who stay four to five days, provided there are no in-hospital complications. This finding was published in the Journal of the American College of Cardiology.
Using data from the ACC's CathPCI Registry linked with Centers for Medicare and Medicaid Services claims data, researchers reviewed records for 33,920 patients between Jan. 6, 2004, and Dec. 21, 2009.
The study found regional differences in length of stay. Patients in hospitals in the West and Midwest tended to have shorter hospital stays than those in the North and Southeast.
Researchers also noted a trend in shorter hospital stays over the course of the study. In 2005, 24 percent of the patients in the study were discharged in fewer than three days, but by 2009, that number had increased to 30 percent. Similarly, 47 percent of patients had stays of four to five days, and 29 percent had remained hospitalized more than five days; by 2009, the stays of four to five days had decreased to 45 percent and long stays of more than five days had decreased to 25 percent, respectively. There was no significant difference in 30-day mortality or major adverse cardiac events between the two groups.
Patients with the longest stays — those over five days — tended to be older, had more comorbidities, and had more extensive coronary vessel disease than patients with medium or short hospital stays.
On the other hand, little was known about the small number of patients who were discharged early, the same day or after an overnight stay. This group had poorer 30-day clinical outcomes, perhaps indicating the need for appropriate inpatient monitoring after the procedure.
"Our study suggests that early discharge after an acute heart attack – but not less than 48 hours after stenting and balloon angioplasty – may be safe among selected older patients who do not develop post-procedural complications,” said Rajesh V. Swaminathan, M.D., FACC, director of interventional cardiology research and assistant professor of medicine at Weill Cornell Medical College/New York-Presbyterian Hospital and the study’s lead author. “The results of this study should prompt physicians to take a closer look at discharge practices in their own institutions for heart attack patients. Many centers, particularly in the North and Southeast, may have the opportunity to shave off at least one hospital day post-angioplasty for their low-risk heart attack patients.”
In an accompanying editorial, Frederic S. Resnic, M.D., M.Sc., of the Department of Cardiovascular Medicine at Lahey Hospital and Medical Center in Burlington, MA, concurred with Swaminathan and his colleagues’ conclusions. Resnic noted, however, that a large randomized trial assessing the safety of an early discharge following primary angioplasty for heart attack patients would provide more complete evidence to assist with discharge decisions.
“The paper by Swaminathan and his colleagues helps affirm that the current practice to discharge lower-risk patients early—after about three days--is likely as safe as longer hospital stays,” continued Resnic. “Given the observed geographic variation, there is likely an opportunity to apply this practice more broadly, thereby achieving significant healthcare cost savings while maintaining the quality of care.”
For more information: www.acc.org
