Same day-discharge is safe, comparable with next day-discharge

SAN FRANCISCO —Same day-discharge was as safe as next day-discharge for patients after elective implantable cardioverter defibrillator implantation, researchers reported at the Heart Rhythm Society Annual Scientific Sessions.

Patients discharged the same day had no difference in quality of life compared with patients discharged the next day, and direct cost differences were not significant, according to the findings.

“Recent studies have pointed to the safety and feasibility of early discharge, but data have been limited,” Ranjit Suri, MD, from Icahn School of Medicine at Mount Sinai, said during a presentation.

Two hundred and sixty-five patients at 30 United States sites who received an ICD for primary prevention of sudden cardiac death and were eligible for use of a ventricular automatic capture algorithm (Merlin@Home, St. Jude Medical) were randomly assigned to either same day-discharge (n = 129) or next day-discharge (n = 136).

“Patients had to be willing to use the Merlin@Home system and live within 50 miles of a hospital,” Suri said.

The primary endpoint was procedural complication rate within 30 days of implantation.

Secondary endpoints included medical costs and quality of life. Patient characteristics did not differ between the groups.

Suri and colleagues found the overall procedural complication rate was 3.2% in same day-discharge patients and 1.5% in next day-discharge patients (HR = 2.18; 95% CI, 0.40-11.91). The researchers did not observe any significant difference in direct medical costs (mean difference, $1,334) or in quality of life between the two study arms.

The researchers called for further research to evaluate cost sources in ambulatory ICD cases, the impact of improved bed availability on patient access and downstream revenue opportunity and the long-term effectiveness of same day-discharge.

“Patient acceptance was not a barrier to same day-discharge and is a very important piece of this strategy,” Suri said. – by Tracey Romero

Reference:

Suri R, et al. LBCT 01. Presented at: Heart Rhythm Society Annual Scientific Sessions; May 4-7, 2016; San Francisco.

Disclosure: Suri reports receiving research funding from Biosense Webster, Boehringer Ingelheim, St. Jude Medical and Zoll Medical.