Does Length of Hospital Stay Affect Outcomes Following PPCI for STEMI?
JACC in a Flash | Patients 65 or older discharged from the hospital as early as 48 hours after primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) have similar outcomes as those who stay four to five days, provided there are no in-hospital complications, according to a recent JACC study.
Using data from the ACC’s CathPCI Registry linked with Centers for Medicare and Medicaid Services (CMS) claims data, researchers assessed 33,920 patients between Jan. 6, 2004, and Dec. 21, 2009. The team followed CMS guidelines for length of stay and defined a short stay as fewer than three days; a medium stay as four to five days; and a long stay as more than five days. A small group of patients with very short stays of one to two days was also evaluated.
Overall, the study showed no significant difference in 30-day mortality or major adverse cardiac events between the groups. However, study authors did observe that patients with the longest stays of more than five days tended to be older, have more comorbidities, and more extensive coronary vessel disease than patients with medium or short hospital stays. While little was known about the characteristics of the small number of patients who were discharged early (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.
Study authors also observed geographic variation in length of stays, with hospitals in the West and Midwest having shorter hospital stays than those in the North and Southeast. The authors also noted an overall trend toward shorter hospital stays over the course of the study. In 2005, 24 percent of STEMI patients were discharged early, but by 2009, that number had increased to 30 percent. Similarly, 47 percent of patients had medium stays, and 29 percent had long stays in 2005; however, by 2009, these numbers had decreased to 45 percent and 25 percent, respectively.
“Our study suggests that early discharge—but not less than 48 hours after PPCI—may be safe among selected older STEMI patients who do not develop post-procedural complications,” said Rajesh V. Swaminathan, MD, FACC, assistant professor of medicine at Weill Cornell Medical College and assistant attending physician at New York-Presbyterian Hospital and the study’s lead author. “The results of this study should prompt physicians to take a closer look at the STEMI discharge practices in their own institutions. Many centers, particularly in the North and Southeast, may have the opportunity to shave off at least one hospital day post-PPCI for their low-risk STEMI patients as a way to optimize healthcare efficiency and bed utilization without compromising clinical outcomes.”
In an accompanying editorial, Frederic S. Resnic, MD, FACC, MSc, of the Department of Cardiovascular Medicine at Lahey Hospital and Medical Center in Burlington, MA, notes that the study “helps affirm that the current practice to discharge lower-risk patients early—after about three days—likely as safe as longer hospital stays. 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 STEMI care.
Swaminathan RV, Rao SV, McCoy LA, et al. J Am Coll Cardiol. 2015;65(12):1161-71.
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