Treatment for patients who have had heart attacks is likely to include a process by which their coronary arteries are widened via percutaneous coronary intervention (PCI). It is one of the most common cardiac procedures currently in use and improves blood flow to the heart by using a catheter to guide a balloon into the arteries. The balloon expands to open the arteries.
Short- and long-term outcomes for PCI patients have continued to improve, but most patients remain in the hospital overnight for observation after the procedure. Small studies have suggested that it is safe to discharge patients on the same day, but no larger analysis has compared outcomes for patients discharged on the same day versus a second-day discharge.
In a new study led by the DCRI’s Sunil Rao, MD, researchers found no significant differences in the number of deaths or readmittances to hospitals, whether the patients were discharged the same day or stayed overnight for observation. If patients who have PCI can be safely discharged on the same day, it would lower hospital costs and free up needed hospital beds.
Study results appear in the October 5 issue of the Journal of the American Medical Association. Researchers analyzed data from the CathPCI Registry for more than 100,000 patients who were 65 years or older and having an elective PCI procedure. The patient data was then linked to Medicare claims. Researchers reviewed death and rehospitalization rates for two days and 30 days after hospital discharge.
Although less than 2 percent of patients were discharged on the same day, those patients had a similar risk for death or rehospitalization compared with patients who were kept overnight. The median time an adverse outcome was experienced by patients discharged on the same day was 13 days. The median time for patients discharged the next day was 14 days.
Current guidelines state that physicians can consider same-day discharge for PCI patients if the patient doesn’t need a prolonged use of medication to prevent blood clots after the procedure and the patient is considered low-risk. The study found that an equal proportion of patients who were considered low-risk and high-risk were kept overnight. Researchers hope the results of this study will help hospitals discharge more low-risk patients on the same day as the PCI procedure.
Other DCRI study co-authors include Lisa Kaltenbach, Matthew Roe, MD, and Eric Peterson, MD, MPH, who was the senior author of the study.
Source: Duke Clinical Research Institute