Early hospital discharge after PCI safe in low-risk patients with STEMI
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In a new study, among low-risk patients who received primary PCI for STEMI, an early discharge pathway was shown to be both safely and successfully integrated.
The findings, which were published recently in the Journal of the American College of Cardiology, indicated a reduction in hospital admission times for those who received the strategy along with an enhancement in the quality of post-discharge care.
For the prospective, observational study, Krishnaraj S. Rathod, PhD, of the Queen Mary University of London, and colleagues sought to determine the safety and feasibility of a novel early hospital discharge pathway for low-risk patients with STEMI.
The study included 600 patients whom the researchers considered at low risk for early MACE. Patients were selected for inclusion in the pathway from March 2020 to June 2021, and were successfully discharged in less than 48 hours.
According to study methodology, at 48 hours after discharge, a cardiac rehabilitation nurse reviewed patients via a structured telephone follow-up. Patients then received a virtual follow-up at 2, 6 and 8 weeks, and 3 months. The pathway, the researchers wrote, was designed and implemented in response to the challenge of the COVID-19 pandemic, which provided them with a unique opportunity for its evaluation.
Results indicated the median length of hospital stay was 24.6 hours compared with a pre-pathway median of 65.9 hours. Patients were contacted after discharge and none were lost to follow-up.
During a median follow-up of 271 days, two patients died (0.33%), with both deaths more than 30 days after discharge and the result of COVID-19. The rate of MACE, defined as all-cause mortality, recurrent MI and target lesion revascularization, was 1.2%.
The researchers compared these figures with a historical control group of 700 patients who met the pathway criteria and remained in the hospital for more than 48 hours, and found favorable results; specifically, the rate of mortality in the control group was 0.7% (P vs. early discharge = .349) and the rate of MACE was 1.9% (P vs. early discharge = .674).
Rathod and colleagues wrote that the cost savings associated with reducing the overall median length of stay from 3 days to 2 days equates to 400 bed-days in the coronary care unit during the period studied.
“This is not only cost-effective, but it would also free beds for improving wider interventional service delivery to address the ever-increasing workload of regional heart attack centers,” they wrote. “The demonstrated low adverse event rate in this patient group offers a strong rationale for a change in standard practice for STEMI care.”
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