1
|
Brandt MC, Alber H, Berger R, Binder RK, Mascherbauer J, Niessner A, Schmid M, Wernly B, Frick M. Same-day discharge after percutaneous coronary procedures-Structured review and comprehensive meta-analysis. Wien Klin Wochenschr 2024; 136:44-60. [PMID: 38743083 PMCID: PMC11093862 DOI: 10.1007/s00508-024-02347-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Percutaneous coronary intervention is a well-established revascularization strategy for patients with coronary artery disease. The safety and feasibility of performing these procedures on a same-day discharge basis for selected patients has been studied in a large number of mostly nonrandomized trials. An up to date literature review should focus on trials with radial access, representing the current standard for coronary procedures in Austria and other European countries. METHODS The aim of this consensus statement is to review the most recent evidence for the safety and feasibility of performing same-day discharge procedures in selected patients. A structured literature search was performed using prespecified search criteria, focusing on trials with radial access procedures. RESULTS A total of 44 clinical trials and 4 large meta-analyses were retrieved, spanning 21 years of clinical evidence from 2001 to 2022. The outcome data from a wide range of clinical settings were unanimous in showing no negative effect on early (24 h) or late (30 day) major adverse events after same-day discharge coronary procedures. Based on nine prospective trials a comprehensive meta-analysis was compiled. Using 1‑month major adverse events data the pooled odds ratio of same-day discharge versus overnight stay procedures was 0.66 (95% confidence interval, CI 0.35-01.24; p = 0.19; I2 0%), indicating a noninferiority in carefully selected patients. CONCLUSION Outcome data from same-day discharge coronary intervention trials with radial access confirm the robust safety profile showing no increase in the risk of major adverse events compared to overnight stay.
Collapse
Affiliation(s)
- Mathias C Brandt
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Hannes Alber
- Department of Cardiology, Public Hospital Klagenfurt am Woerthersee, Klagenfurt am Woerthersee, Austria
| | - Rudolf Berger
- Department of Internal Medicine, Brothers of Saint John of God Eisenstadt, Eisenstadt, Austria
| | - Ronald K Binder
- Department of Cardiology and Intensive Care, Klinikum Wels, Wels, Austria
| | - Julia Mascherbauer
- Department of Internal Medicine 3/Cardiology, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Alexander Niessner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Martin Schmid
- Department of Cardiology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Bernhard Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - Matthias Frick
- Department of Internal Medicine I and Cardiology, Teaching Hospital Feldkirch, Feldkirch, Austria
| |
Collapse
|
2
|
Brandt MC, Alber H, Berger R, Binder RK, Mascherbauer J, Niessner A, Schmid M, Frick M. Same-day discharge after percutaneous coronary procedures-Consensus statement of the working group of interventional cardiology (AGIK) of the Austrian Society of Cardiology. Wien Klin Wochenschr 2024; 136:61-74. [PMID: 38743084 PMCID: PMC11093795 DOI: 10.1007/s00508-024-02348-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Percutaneous coronary intervention is a well-established revascularization strategy for patients with coronary artery disease. Recent technical advances such as radial access, third generation drug-eluting stents and highly effective antiplatelet therapy have substantially improved the safety profile of coronary procedures. Despite several practice guidelines and a clear patient preference of early hospital discharge, the percentage of coronary procedures performed in an outpatient setting in Austria remains low, mostly due to safety concerns. METHODS The aim of this consensus statement is to provide a practical framework for the safe and effective implementation of coronary outpatient clinics in Austria. Based on a structured literature review and an in-depth analysis of available practice guidelines a consensus statement was developed and peer-reviewed within the working group of interventional cardiology (AGIK) of the Austrian Society of Cardiology. RESULTS Based on the available literature same-day discharge coronary procedures show a favorable safety profile with no increase in the risk of major adverse events compared to an overnight stay. This document provides a detailed consensus in various clinical settings. The most important prerequisite for same-day discharge is, however, adequate selection of suitable patients and a structured peri-interventional and postinterventional management plan. CONCLUSION Based on the data analysis this consensus document provides detailed practice guidelines for the safe operation of daycare cathlab programs in Austria.
Collapse
Affiliation(s)
- Mathias C Brandt
- Department of Internal Medicine II, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Hannes Alber
- Department of Cardiology, Public Hospital Klagenfurt am Woerthersee, Klagenfurt am Woerthersee, Austria
| | - Rudolf Berger
- Department of Internal Medicine, Brothers of Saint John of God Eisenstadt, Eisenstadt, Austria
| | - Ronald K Binder
- Department of Cardiology and Intensive Care, Klinikum Wels, Wels, Austria
| | - Julia Mascherbauer
- Department of Internal Medicine 3/Cardiology, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Martin Schmid
- Department of Cardiology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Matthias Frick
- Department of Internal Medicine I and Cardiology, Teaching Hospital Feldkirch, Feldkirch, Austria
| |
Collapse
|
3
|
Ginete WL, Groth NA, Rudeck MN, Renier CM, Benziger CP. Outcomes of same-day discharge following percutaneous coronary intervention in a rural population. Catheter Cardiovasc Interv 2023; 102:472-480. [PMID: 37483104 DOI: 10.1002/ccd.30762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/26/2023] [Accepted: 06/14/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Same-day discharge (SDD) following percutaneous coronary intervention (PCI) is safe, yet the nationwide rate of SDD remains low. The impact that residing in a rural area has on the safety of SDD is unknown. OBJECTIVE To investigate the safety of SDD compared to next-day discharge (NDD) among PCI patients living in a largely rural area. METHODS There were 3502 outpatient elective PCIs at a tertiary care center between January 1, 2011 and December 31, 2017. Data from the National Cardiovascular Data Registry CathPCI Registry® and the electronic medical records were obtained for patient demographics, procedural characteristics, and procedural outcomes. Data from the initial PCI in each 365-day period were included in the analysis for each patient. Rural-Urban Commuting Area codes 4-10 were used to define rural status. RESULTS A total of 2099 (59.9%) PCIs met the inclusion criteria (63% rural). The overall rate of SDD increased over time (4.7% in 2011 to 39.6% in 2017) as radial access increased (14.2% in 2011 to 59.9% in 2017). In this population, a total of 329 PCIs had SDD (15.7%; median (interquartile range) age 66.0 (14.0) years, 20.1% female, 52.3% rural status). Compared to NDD, SDD patients had less hyperlipidemia, atrial fibrillation, congestive heart failure, history of coronary artery bypass graft, and more radial access. SDD was noninferior to NDD for 30-day readmission but had a decreased 1-year (adjusted odds ratio [aOR]: 0.20, 95% confidence interval [CI]: 0.05-0.81, p = 0.024) and 5-year (aOR: 0.43, 95% CI: 0.28-0.66, p < 0.001) all-cause mortality compared to NDD. Rural status did not predict outcomes. CONCLUSIONS SDD in patients in rural areas does not have a significantly higher rate of 30-day readmission. SDD patients had lower odds of 1- and 5-year mortality when compared to NDD. Future studies prospectively evaluating the safety of SDD in this population are warranted.
Collapse
Affiliation(s)
- Wilson L Ginete
- Essentia Health Heart and Vascular Center, Duluth, Minnesota, USA
| | - Nicole A Groth
- Essentia Institute of Rural Health, Duluth, Minnesota, USA
| | | | | | | |
Collapse
|
4
|
Krishnaswamy A, Isogai T, Brilakis ES, Nanjundappa A, Ziada KM, Parikh SA, Rodés-Cabau J, Windecker S, Kapadia SR. Same-Day Discharge After Elective Percutaneous Transcatheter Cardiovascular Interventions. JACC Cardiovasc Interv 2023; 16:1561-1578. [PMID: 37438024 DOI: 10.1016/j.jcin.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/23/2023] [Accepted: 05/08/2023] [Indexed: 07/14/2023]
Abstract
Percutaneous transcatheter interventions have evolved as standard therapies for a variety of cardiovascular diseases, from revascularization for atherosclerotic vascular lesions to the treatment of structural cardiac diseases. Concomitant technological innovations, procedural advancements, and operator experience have contributed to effective therapies with low complication rates, making early hospital discharge safe and common. Same-day discharge presents numerous potential benefits for patients, providers, and health care systems. There are several key elements that are shared across the spectrum of interventional cardiology procedures to create a successful same-day discharge pathway. These include appropriate patient and procedure selection, close postprocedural observation, predischarge assessments specific for each type of procedure, and the existence of a patient support system beyond hospital discharge. This review provides the rationale, available data, and a framework for same-day discharge across the spectrum of coronary, peripheral, and structural cardiovascular interventions.
Collapse
Affiliation(s)
- Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Aravinda Nanjundappa
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Khaled M Ziada
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sahil A Parikh
- Division of Cardiology and Center for Interventional Vascular Therapy, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
| |
Collapse
|
5
|
Setogawa N, Ohbe H, Isogai T, Matsui H, Yasunaga H. Characteristics and short-term outcomes of outpatient and inpatient cardiac catheterizations: A descriptive study using a nationwide claim database in Japan. J Cardiol 2023:S0914-5087(23)00125-9. [PMID: 37247658 DOI: 10.1016/j.jjcc.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Most previous studies on outpatient cardiac catheterization have been conducted in Western countries, but Japanese studies are rare. We aimed to describe patient characteristics and short-term clinical outcomes of outpatient cardiac catheterization compared to those of inpatient cardiac catheterization in Japan. METHODS We conducted a retrospective cohort study using data from the JMDC Claims Database. We identified all adult patients aged ≥18 years who underwent cardiac catheterization between April 2012 and October 2021. We investigated patient characteristics and clinical outcomes (i.e. all-cause mortality, stroke, acute kidney injury, bleeding, vascular complications, percutaneous coronary intervention, and total healthcare costs) within 2, 7, and 30 days between patients who underwent outpatient cardiac catheterization (outpatient group) and those who underwent inpatient cardiac catheterization (inpatient group). RESULTS Of the 37,002 eligible patients (57.6 % <60 years old, and 80.2 % male), 1853 (5.01 %) underwent outpatient cardiac catheterization. The outpatient group was more likely to be male, have more comorbidities, and be performed at non-university hospitals than the inpatient group. The proportion of patients who underwent right heart catheterization and imaging was lower in the outpatient group. There were no significant differences in 7-day major complications between the two groups (all-cause mortality, 0.0 % versus 0.0 %, p = 0.57; acute kidney injury, 0.0 % versus 0.1 %, p = 0.10, bleeding, 0.5 % versus 0.9 %, p = 0.052; vascular complication, 0.0 % versus 0.1 %, p = 0.23, respectively). The 30-day total healthcare costs were lower in the outpatient group than in the inpatient group (mean 3212 US dollars versus 3955 US dollars, p = 0.003). CONCLUSIONS Approximately 5 % of cardiac catheterizations were performed in an outpatient setting. Given the low adverse event risk observed in this study, it may be a reasonable option to widen outpatient cardiac catheterization to include potential populations in Japan, warranting further studies.
Collapse
Affiliation(s)
- Nao Setogawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Toshiaki Isogai
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
6
|
Safety of short 3-hour recovery and same-day discharge following lower-limb angioplasty in outpatients with intermittent claudication and critical limb ischaemia. Clin Radiol 2023; 78:e182-e189. [PMID: 36462943 DOI: 10.1016/j.crad.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 09/21/2022] [Accepted: 10/13/2022] [Indexed: 12/03/2022]
Abstract
AIM To investigate the safety and efficacy of short recovery day-case pathway following lower-limb angioplasty in both intermittent claudication and critical limb ischaemia patients. MATERIALS AND METHODS A retrospective analysis was undertaken of the medical records of consecutive outpatients treated with lower-limb angioplasty over a 1-year period within an interventional radiology (IR) day-case unit in a high-volume vascular centre. Standard post-angioplasty care at York Teaching Hospital is discharge 3 h after puncture site haemostasis without the routine use of closure devices. The rates of successful same-day discharge, procedure success, complications, and re-admissions were calculated with 30-day follow-up. RESULTS The cohort included 301 patients (57% intermittent claudication and 43% critical limb ischaemia) undergoing 605 angioplasties using access sheath size ranging from 4 to 7 F. Closure devices were used in only 7% of patients. Successful same-day discharge achieved in 98% of patients (294/301), with seven admitted overnight because of complications. Eleven patients (3.6%) were re-admitted within 30 days. Technical success rates were 92%, and 96% when including partially successful interventions, with 4% technical failure. Twelve patients (4%) developed minor complications and four major complications (1%). There were no significant differences in complication rates between small and larger sheath sizes (p>0.05). No procedure-related death was recorded within 30 days. CONCLUSION Lower-limb angioplasty can be performed safely as day-case procedure with a short recovery protocol within IR departments for both patients with intermittent claudication (IC) and critical limb ischaemia (CLI). This may significantly increase patient throughput and alleviate pressure on stretched hospital inpatient resources by safely discharging patients on the day of procedure.
Collapse
|
7
|
Aquino GSLDM, Botelho JB, Matsuda CN, Silva MAD, Janella BL. Sigle-center, observational, prospective study describing same-day discharge implementation for uncomplicated elective percutaneous coronary intervention by radial approach: Study protocol. REVISTA CIÊNCIAS EM SAÚDE 2021. [DOI: 10.21876/rcshci.v11i3.1123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives: The study's primary objective will be to evaluate the safety and describe the initial experience of implementing early discharge (on the same day) of coronary patients from the Unified Health System undergoing elective, uncomplicated, transradial percutaneous coronary intervention. The secondary objective will be to assess the impact on the direct cost per patient compared to previously known data from the classic hospital stay used (hospital overnight). Methods: Observational and prospective study of patients undergoing elective uncomplicated transradial percutaneous coronary intervention with early discharge, respecting the inclusion and exclusion criteria. Follow-up of patients will be carried out to prove the safety of the new strategy in the population of the Unified Health System and to compare the direct costs between overnight stays and discharge on the same day. This will be the first study dedicated to primarily evaluating the safety of early discharge after elective uncomplicated transradial coronary angioplasty, validating this protocol in the population of the Brazilian public health system.
Collapse
|
8
|
Bradley SM, Kaltenbach LA, Xiang K, Amin AP, Hess PL, Maddox TM, Poulose A, Brilakis ES, Sorajja P, Ho PM, Rao SV. Trends in Use and Outcomes of Same-Day Discharge Following Elective Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2021; 14:1655-1666. [PMID: 34353597 DOI: 10.1016/j.jcin.2021.05.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/26/2021] [Accepted: 05/25/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aims of this study were to describe trends and hospital variation in same-day discharge following elective percutaneous coronary intervention (PCI) and to evaluate the association between trends in same-day discharge and patient outcomes. BACKGROUND Insights on contemporary use of same-day discharge following elective PCI are limited. METHODS In a sequential cross-sectional analysis of 819,091 patients undergoing elective PCI at 1,716 hospitals in the National Cardiovascular Data Registry CathPCI Registry from July 1, 2009, to December 31, 2017, overall and hospital-level trends in same-day discharge were assessed. Among the 212,369 patients who linked to Centers for Medicare and Medicaid Services data, the association between same-day discharge and 30-day mortality and rehospitalization was assessed. RESULTS A total of 114,461 patients (14.0%) were discharged the same day as PCI. The proportion of patients with same-day discharge increased from 4.5% in the third quarter of 2009 to 28.6% in the fourth quarter of 2017. From 2009 to 2017, the rate of same-day discharge increased from 4.3% to 19.5% for femoral-access PCI and from 9.9% to 39.7% for radial-access PCI. Hospital-level variation in the use of same-day discharge persisted throughout (median odds ratio adjusted for year and radial access: 4.15). Risk-adjusted 30-day mortality did not change over time, while risk-adjusted rehospitalization decreased over time and more quickly for same-day discharge (P for interaction <0.001). CONCLUSIONS In the past decade, a large increase in the use of same-day discharge following elective PCI was not associated with worse 30-day mortality or rehospitalization. Hospital-level variation in same-day discharge may represent an opportunity to reduce costs without compromising patient outcomes.
Collapse
Affiliation(s)
- Steven M Bradley
- Minneapolis Heart Institute, Minneapolis, Minnesota, USA; Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
| | | | - Katelyn Xiang
- The Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Amit P Amin
- Healthcare Innovation Lab, BJC HealthCare/Washington University School of Medicine, St. Louis, Missouri, USA
| | - Paul L Hess
- Division of Cardiology, Washington University School of Medicine, Saint Louis, Missouri, USA; VA Eastern Colorado Health Care System, Aurora, Colorado, USA; University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Thomas M Maddox
- Healthcare Innovation Lab, BJC HealthCare/Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anil Poulose
- Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Minneapolis, Minnesota, USA; Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Paul Sorajja
- Minneapolis Heart Institute, Minneapolis, Minnesota, USA; Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - P Michael Ho
- Division of Cardiology, Washington University School of Medicine, Saint Louis, Missouri, USA; VA Eastern Colorado Health Care System, Aurora, Colorado, USA; University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sunil V Rao
- The Duke Clinical Research Institute, Durham, North Carolina, USA
| |
Collapse
|
9
|
Naidu SS, Abbott JD, Bagai J, Blankenship J, Garcia S, Iqbal SN, Kaul P, Khuddus MA, Kirkwood L, Manoukian SV, Patel MR, Skelding K, Slotwiner D, Swaminathan RV, Welt FG, Kolansky DM. SCAI expert consensus update on best practices in the cardiac catheterization laboratory: This statement was endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), and the Heart Rhythm Society (HRS) in April 2021. Catheter Cardiovasc Interv 2021; 98:255-276. [PMID: 33909349 DOI: 10.1002/ccd.29744] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 04/23/2021] [Indexed: 12/28/2022]
Abstract
The current document commissioned by the Society for Cardiovascular Angiography and Interventions (SCAI) and endorsed by the American College of Cardiology, the American Heart Association, and Heart Rhythm Society represents a comprehensive update to the 2012 and 2016 consensus documents on patient-centered best practices in the cardiac catheterization laboratory. Comprising updates to staffing and credentialing, as well as evidence-based updates to the pre-, intra-, and post-procedural logistics, clinical standards and patient flow, the document also includes an expanded section on CCL governance, administration, and approach to quality metrics. This update also acknowledges the collaboration with various specialties, including discussion of the heart team approach to management, and working with electrophysiology colleagues in particular. It is hoped that this document will be utilized by hospitals, health systems, as well as regulatory bodies involved in assuring and maintaining quality, safety, efficiency, and cost-effectiveness of patient throughput in this high volume area.
Collapse
Affiliation(s)
- Srihari S Naidu
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - J Dawn Abbott
- Cardiovascular Institute of Lifespan, Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jayant Bagai
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James Blankenship
- Cardiology Division, The University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Sohah N Iqbal
- Mass General Brigham Salem Hospital, Salem, Massachusetts, USA
| | | | - Matheen A Khuddus
- The Cardiac and Vascular Institute and North Florida Regional Medical Center, Gainesville, Florida, USA
| | - Lorrena Kirkwood
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | | | - Manesh R Patel
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - David Slotwiner
- Division of Cardiology, New York Presbyterian, Weill Cornell Medicine Population Health Sciences, Queens, New York, USA
| | - Rajesh V Swaminathan
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Frederick G Welt
- Division of Cardiovascular Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Daniel M Kolansky
- Division of Cardiovascular Medicine, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
10
|
Rao SV, Vidovich MI, Gilchrist IC, Gulati R, Gutierrez JA, Hess CN, Kaul P, Martinez SC, Rymer J. 2021 ACC Expert Consensus Decision Pathway on Same-Day Discharge After Percutaneous Coronary Intervention: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2021; 77:811-825. [PMID: 33423859 DOI: 10.1016/j.jacc.2020.11.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
11
|
Li K, Kalwani NM, Heidenreich PA, Fearon WF. Elective Percutaneous Coronary Intervention in Ambulatory Surgery Centers. JACC Cardiovasc Interv 2020; 14:292-300. [PMID: 33183992 DOI: 10.1016/j.jcin.2020.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/05/2020] [Accepted: 10/13/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to explore characteristics and outcomes of patients undergoing elective percutaneous coronary intervention (PCI) in ambulatory surgery centers (ASCs). BACKGROUND Little is known about patients who underwent ASC PCI before Medicare reimbursement was instituted in 2020. METHODS Using commercial insurance claims from MarketScan, adults who underwent hospital outpatient department (HOPD) or ASC PCI for stable ischemic heart disease from 2007 to 2016 were studied. Propensity score analysis was used to measure the association between treatment setting and the primary composite outcome of 30-day myocardial infarction, bleeding complications, and hospital admission. RESULTS The unmatched sample consisted of 95,492 HOPD and 849 ASC PCIs. Patients who underwent ASC PCI were more likely to be younger than 65 years, to live in the southern United States, and to have managed or consumer-driven health insurance. ASC PCI was also associated with decreased fractional flow reserve utilization (odds ratio [OR]: 0.31; 95% confidence interval [CI]: 0.20 to 0.48; p < 0.001). In unmatched, multivariate analysis, ASC PCI was associated with increased odds of the primary outcome (OR: 1.25; 95% CI: 1.01 to 1.56; p = 0.039) and bleeding complications (OR: 1.80; 95% CI: 1.11 to 2.90; p = 0.016). In propensity-matched analysis, ASC PCI was not associated with the primary outcome (OR: 1.23; 95% CI: 0.94 to 1.60; p = 0.124) but was significantly associated with increased bleeding complications (OR: 2.49; 95% CI: 1.25 to 4.95; p = 0.009). CONCLUSIONS Commercially insured patients undergoing ASC PCI were less likely to undergo fractional flow reserve testing and had higher odds of bleeding complications than HOPD-treated patients. Further study is warranted as Medicare ASC PCI volume increases.
Collapse
Affiliation(s)
- Kevin Li
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Neil M Kalwani
- Division of Cardiovascular Medicine, Department of Medicine, Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA
| | - Paul A Heidenreich
- Division of Cardiovascular Medicine, Department of Medicine, Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA
| | - William F Fearon
- Division of Cardiovascular Medicine, Department of Medicine, Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA.
| |
Collapse
|
12
|
Same-day discharge after elective percutaneous coronary intervention: A single center experience. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2019.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
13
|
Rodrigues A, Silva M, Almeida C, Ferreira FC, Morais GPD, Santos L, Melica B, Braga P. Same-day discharge after elective percutaneous coronary intervention: A single center experience. Rev Port Cardiol 2020; 39:443-449. [PMID: 32723680 DOI: 10.1016/j.repc.2019.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/26/2019] [Accepted: 10/12/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Elective percutaneous coronary intervention (PCI) has become an increasingly safe procedure. However, same day discharge (SDD) has yet to become standard practice. Our aim is to characterize the patients who underwent elective PCI and compare outcomes between the overnight stay (ONS) patient group and the group that was discharged on the same day at 24 hours and at 30 days. METHODS One-year registry of patients who underwent an elective PCI. The possibility of SDD was established by the operator. Appropriate candidates were discharged at least four hours after the end of the intervention. The primary endpoints were defined as: Major adverse cardiac and cerebrovascular events (MACCE) - death, myocardial infarction (MI) stroke or transient ischemic attack (TIA), non-planned re-intervention - and vascular complications. Secondary endpoints were any unplanned hospital visit, readmission and re-catheterization. RESULTS We performed 155 elective PCIs. One patient was admitted to the coronary care unit; 111 patients stayed overnight (ONS Group); 43 patients were discharged the same day (SDD Group). Three patients had early (<4 hours) post procedure complications: two TIAs and one vascular access site complication. There were no MACCE between four and 24 hours, nor at 30 days. At 24 hours, two patients from the SDD group had unplanned visits. Between one and 30 days, more patients from the SDD group had unplanned visits (9.3% vs. 0.9%. p=0.02). One patient from the ONS group had a recatherization. There were no readmissions or reinterventions. CONCLUSION Same day discharge of selected patients who undergo elective PCIs is feasible and safe.
Collapse
Affiliation(s)
| | - Mariana Silva
- Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Carla Almeida
- Hospital do Divino Espírito Santo de Ponta Delgada, Ponta Delgada, Açores, Portugal
| | | | | | - Lino Santos
- Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Bruno Melica
- Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Pedro Braga
- Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
| |
Collapse
|
14
|
Taxiarchi P, Kontopantelis E, Kinnaird T, Curzen N, Banning A, Ludman P, Shoaib A, Rashid M, Martin GP, Mamas MA. Adoption of same day discharge following elective left main stem percutaneous coronary intervention. Int J Cardiol 2020; 321:38-47. [PMID: 32739446 PMCID: PMC7392050 DOI: 10.1016/j.ijcard.2020.07.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/04/2020] [Accepted: 07/24/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study sought to investigate the safety and feasibility of same day discharge (SDD) practice and compare clinical outcomes to patients admitted for overnight stay (ON) undergoing elective left main stem (LMS) percutaneous coronary intervention (PCI). ON observation is still widely practiced in highly complex PCI as the standard of care, with no previous data comparing clinical outcomes in patients undergoing LMS PCI. METHODS We analysed 6452 patients undergoing elective LMS PCI between 2007 and 2014 in England and Wales. Multiple logistic regressions and the BCIS risk model were used to study association between SDD and 30 day mortality. RESULTS SDD rates almost doubled from 19.9% in 2007 to 39.8% in 2014 for all LMS procedures and increased from 20.7% to 41.4% for unprotected LMS cases during the same study period. There was a significant increase in procedural complexity with higher use of rotational atherectomy, longer stents and multivessel PCI. SDD was not associated with increased 30 day mortality (OR 0.70 95%CI 0.30-1.65) in the overall LMS PCI cohort and the results were similar in unprotected LMS (OR 0.48 95%CI 0.17-1.41) and those requiring ON stay (OR 0.58 95%CI 0.25-1.34). CONCLUSIONS We did not find evidence that SDD is not safe or feasible in highly complex LMS PCI procedures despite increasing procedural complexity with no significant increase in 30 day mortality rates.
Collapse
Affiliation(s)
- Paraskevi Taxiarchi
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Nick Curzen
- Coronary Research Group, University Hospital Southampton, Faculty of Medicine, University of Southampton, UK
| | | | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Ahmad Shoaib
- Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, University of Keele and Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, University of Keele and Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Glen P Martin
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Mamas A Mamas
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, University of Keele and Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK.
| |
Collapse
|
15
|
Jang S, Yeo I, Feldman DN, Cheung JW, Minutello RM, Singh HS, Bergman G, Wong SC, Kim LK. Associations Between Hospital Length of Stay, 30-Day Readmission, and Costs in ST-Segment-Elevation Myocardial Infarction After Primary Percutaneous Coronary Intervention: A Nationwide Readmissions Database Analysis. J Am Heart Assoc 2020; 9:e015503. [PMID: 32468933 PMCID: PMC7428974 DOI: 10.1161/jaha.119.015503] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Readmission after ST-segment-elevation myocardial infarction (STEMI) poses an enormous economic burden to the US healthcare system. There are limited data on the association between length of hospital stay (LOS), readmission rate, and overall costs in patients who underwent primary percutaneous coronary intervention for STEMI. Methods and Results All STEMI hospitalizations were selected in the Nationwide Readmissions Database from 2010 to 2014. From the patients who underwent primary percutaneous coronary intervention, we examined the 30-day outcomes including readmission, mortality, reinfarction, repeat revascularization, and hospital charges/costs according to LOS (1-2, 3, 4, 5, and >5 days) stratified by infarct locations. The 30-day readmission rate after percutaneous coronary intervention for STEMI was 12.0% in the anterior wall (AW) STEMI group and 9.9% in the non-AW STEMI group. Patients with a very short LOS (1-2 days) were readmitted less frequently than those with a longer LOS regardless of infarct locations. However, patients with a very short LOS had significantly increased 30-day readmission mortality versus an LOS of 3 days (hazard ratio, 1.91; CI, 1.16-3.16 [P=0.01]) only in the AW STEMI group. Total costs (index admission+readmission) were the lowest in the very short LOS cohort in both the AW STEMI group (P<0.001) and the non-AW STEMI group (P<0.001). Conclusions For patients who underwent primary percutaneous coronary intervention for STEMI, a very short LOS was associated with significantly lower 30-day readmission and lower cumulative cost. However, a very short LOS was associated with higher 30-day mortality compared with at least a 3-day stay in the AW STEMI cohort.
Collapse
Affiliation(s)
- Sun‐Joo Jang
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell MedicineNew York Presbyterian HospitalNew YorkNY
- Dalio Institute of Cardiovascular ImagingDepartment of RadiologyWeill Cornell MedicineNew York Presbyterian HospitalNew YorkNY
| | - Ilhwan Yeo
- Division of CardiologyNew York Presbyterian Queens HospitalNew YorkNY
- Icahn School of Medicine at Mount SinaiNew YorkNY
| | - Dmitriy N. Feldman
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell MedicineNew York Presbyterian HospitalNew YorkNY
| | - Jim W. Cheung
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell MedicineNew York Presbyterian HospitalNew YorkNY
| | - Robert M. Minutello
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell MedicineNew York Presbyterian HospitalNew YorkNY
| | - Harsimran S. Singh
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell MedicineNew York Presbyterian HospitalNew YorkNY
| | - Geoffrey Bergman
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell MedicineNew York Presbyterian HospitalNew YorkNY
| | - S. Chiu Wong
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell MedicineNew York Presbyterian HospitalNew YorkNY
| | - Luke K. Kim
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell MedicineNew York Presbyterian HospitalNew YorkNY
| |
Collapse
|
16
|
Periprocedural Myocardial Injury: Pathophysiology, Prognosis, and Prevention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1041-1052. [PMID: 32586745 DOI: 10.1016/j.carrev.2020.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 01/27/2023]
Abstract
The definition and clinical implications of myocardial infarction occurring in the setting of percutaneous coronary intervention have been the subject of unresolved controversy. The definitions of periprocedural myocardial infarction (PMI) are many and have evolved over recent years. Additionally, the recent advancement of different imaging modalities has provided useful information on a patients' pre-procedural risk of myocardial infarction. Nonetheless, questions on the benefit of different approaches to prevent PMI and their practical implementation remain open. This review aims to address these questions and to provide a current and contemporary perspective.
Collapse
|
17
|
Cost-effectiveness and Outcomes with Early or Same-Day Discharge After Elective Percutaneous Coronary Intervention. Curr Cardiol Rep 2020; 22:42. [PMID: 32430629 DOI: 10.1007/s11886-020-01286-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW Shorter hospital stay after percutaneous coronary intervention (PCI) can provide economic advantage. Same-day discharge (SDD) after transradial PCI is thought to reduce the cost of care while maintaining the quality and safety. This review summarizes the current knowledge of the benefits and safety of this concept. RECENT FINDINGS Increase in rate of transradial PCI over the last two decades has resulted in recent growth in rate of acceptance of SDD after a successful procedure. SDD is shown to result in savings of $3500 to $5200 per procedure with comparable adverse event rate of traditional discharge processes. SDD after PCI is shown to be safe and results in cost advantage maintaining the safety profile. The acceptance rate of SDD is still not optimum, and further market penetration of SDD practice would be achieved only if the institutional and operator preference barriers are addressed.
Collapse
|
18
|
Basinkevich AB, Matchin YG, Ageev FT. [Safety and clinical-cost effectiveness of percutaneous coronary interventions with overnight hospitalization]. TERAPEVT ARKH 2020; 92:127-134. [PMID: 32598710 DOI: 10.26442/00403660.2020.04.000532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Indexed: 11/22/2022]
Abstract
New methods and treatment plans for patients with chronic coronary artery disease after endovascular interventions are currently introduced into clinical practice. It allows reducing hospital stay down to 24 hour, with discharge the next morning. This approach is called overnight stay. Using a similar strategy increases the availability of various types of endovascular interventions, shorter waiting lists, and cut the cost of treatment due to a reduced hospital stay.
Collapse
Affiliation(s)
| | - Y G Matchin
- National Medical Research Center of Cardiology
| | - F T Ageev
- National Medical Research Center of Cardiology
| |
Collapse
|
19
|
Oseran AS, Wasfy JH. Editorial: Same-Day Discharge after Percutaneous Coronary Interventions: A Potential Response to Policy Incentives to Improve Value in Cardiology Care. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:592-593. [PMID: 32169405 DOI: 10.1016/j.carrev.2020.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Andrew S Oseran
- Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA United States of America
| | - Jason H Wasfy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA United States of America.
| |
Collapse
|
20
|
The Feasibility and Safety of Same-Day Discharge for All Comers after Elective Percutaneous Coronary Interventions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:588-591. [PMID: 31767522 DOI: 10.1016/j.carrev.2019.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 09/28/2019] [Accepted: 09/30/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The safety of same day discharge (SDD) after percutaneous coronary interventions (PCI) has been demonstrated in several studies. However, SDD was only allowed in patients meeting strict criteria. We aimed to evaluate the feasibility and safety of SDD following elective-PCI in all comers. METHODS In 2012, we implemented a strategy of SDD for all elective PCI (no exclusion) but admissions were allowed at the discretion of the treating physician. We assessed the feasibility and safety of this approach in consecutive patients who underwent elective PCI at WVU. RESULTS Out of 3355 patients who underwent PCI between 2012 and 2016, 691 (21%) presented electively. Radial access was utilized in 480 (69.5%). Same day discharge was achieved in 539/691 (78%), and there was no difference between patients who had SDD and those who were admitted with regards to the 30-day major adverse cardiovascular and cerebrovascular events (3.2% vs. 3.5% respectively, P = 0.195). Predictors of SDD failure were procedural complications (OR 12.08, 95%CI 2.20-57.8. P = 0.002), use of Glycoprotein IIB-IIIA inhibitors (OR 3.45, 95%CI 1.067-11.41, P = 0.039), femoral access (OR 2.067, 95%CI 1.25-3.419, p = 0.005), anemia (OR 1.80, 95%CI 1.06-3.04, P = 0.029), home distance ≥60 miles (OR 1.68, 95%CI 1.03-2.72, P = 0.037). CONCLUSION SDD is feasible in the majority of all-comers after elective PCI, and is not associated with increase in adverse events at 30-days. Certain procedural and patient's characteristics predict SDD failure. If validated in prospective studies, these factors can possibly be integrated in a predictive tool to aid in triaging patients, post-elective PCI.
Collapse
|
21
|
Li S, Li Z, Hou X, Sun J, Kang L, Cheng Y, Tao Y, Li Z, Chen X, Zhang D, Yan X, Wang S, Gao Y, Wang Q, Lin Y, Yin C, Zhang J, Gao Y, Huang J, Wu X, Li N, Su W, Liu H, Sun T. Safety and cost analysis of early discharge following percutaneous coronary intervention for acute coronary syndrome in patients with diabetes mellitus. J Int Med Res 2019; 47:3905-3917. [PMID: 31189388 PMCID: PMC6726824 DOI: 10.1177/0300060519842777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the safety and cost of early discharge compared with ordinary discharge in patients with diabetes mellitus (DM) following percutaneous coronary intervention (PCI) for acute coronary syndrome. Methods We performed a retrospective analysis of prospectively collected data from 474 patients with DM who were discharged from hospital following PCI at a regional center between 2012 and 2015. Results A total of 192 patients (40.5%) were included in the early discharge group and 282 patients (59.5%) were included in the ordinary group. Mortality and morbidity after PCI were recorded. Kaplan–Meier analysis showed similar prognosis between the two groups at 30 days and at 1 year after discharge. However, hospitalization expenses for the regular discharge group were significantly higher than those of the early discharge group (RMB65,750 vs. RMB50,983). Conclusion Our findings demonstrate that early discharge of patients with DM following PCI for acute coronary syndrome is safe compared with ordinary discharge, and may reduce hospitalization costs.
Collapse
Affiliation(s)
- Shihong Li
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Zhizhong Li
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Xuejian Hou
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Junping Sun
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Lihui Kang
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Yutong Cheng
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Ying Tao
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Zhao Li
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Xuanzu Chen
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Donghua Zhang
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Xianliang Yan
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Su Wang
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Yulong Gao
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Qian Wang
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Yun Lin
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Chengqian Yin
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Jingmei Zhang
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Yun Gao
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Ji Huang
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Xiangyu Wu
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Nan Li
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Wang Su
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Honghong Liu
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Tao Sun
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
22
|
Safety of elective percutaneous peripheral revascularization in outpatients: A 10-year single-center experience. Diagn Interv Imaging 2019; 100:347-352. [DOI: 10.1016/j.diii.2018.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/21/2018] [Accepted: 11/22/2018] [Indexed: 11/19/2022]
|
23
|
Wang G, Zhao Q, Cheng Q, Zhang X, Tian L, Wu X. Comparison short time discharge with long time discharge following uncomplicated percutaneous coronary intervention for Non-ST elevation myocardial infarction patients. BMC Cardiovasc Disord 2019; 19:109. [PMID: 31088360 PMCID: PMC6518450 DOI: 10.1186/s12872-019-1096-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 05/03/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The rational length of stay following non-complicated percutaneous coronary intervention (PCI) for Non-ST elevation myocardial infarction (NSTEMI) patients remains controversial. Few studies have examined the impact of early discharge on short-term outcomes in NSTEMI patients, but short-time discharge is not uncommon in real world practice. This study examined the impact of short time discharge following non-complicated PCI on 30-day net adverse clinical events in NSTEMI patients. METHODS This retrospective study enrolled 1424 consecutive patients with NSTEMI diagnoses who underwent non-complicated PCI. Of these patients, 432 were discharged early (< 24 h), whereas the remaining 992 NSTEMI patients underwent routine discharge. The primary end points of the study were the net adverse clinical events including major adverse cardiac or cerebral events or access site vascular/bleeding complications within 30 days. The differences between the two groups were analyzed after propensity score matching to reduce selection bias. RESULTS The incidence of crude 30-day net adverse events was numerically higher in the long-time discharge group at 11.6% (115/992) compared with 8.6% (37/432) in the short-time discharge group, although this difference was not significant (P = 0.09). This difference was mainly due to lesser radial access selected in the long-time discharge group (827/932, 83.4% vs. 387/432, 89.5%, P < 0.0005). After PS matching to balance the access difference, there was no significant difference in the incidence of the events mentioned above between two groups. CONCLUSIONS If an NSTEMI patient undergoes PCI without any procedural or hospital complications, short-time discharge after successful PCI would be feasible and safe in selected NSTEMI patients.
Collapse
Affiliation(s)
- Guozhong Wang
- Cardiology Department of Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart ,Lung and Blood Vessel Diseases, Chaoyang district AnzhenRoad 2#, Beijing, China.
| | - Quanming Zhao
- Cardiology Department of Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart ,Lung and Blood Vessel Diseases, Chaoyang district AnzhenRoad 2#, Beijing, China
| | - Qing Cheng
- Cardiology Department of Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart ,Lung and Blood Vessel Diseases, Chaoyang district AnzhenRoad 2#, Beijing, China
| | - Xiaoxia Zhang
- Cardiology Department of Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart ,Lung and Blood Vessel Diseases, Chaoyang district AnzhenRoad 2#, Beijing, China
| | - Lei Tian
- Cardiology Department of Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart ,Lung and Blood Vessel Diseases, Chaoyang district AnzhenRoad 2#, Beijing, China
| | - Xiaofan Wu
- Cardiology Department of Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart ,Lung and Blood Vessel Diseases, Chaoyang district AnzhenRoad 2#, Beijing, China
| |
Collapse
|
24
|
Córdoba-Soriano JG, Rivera-Juárez A, Gutiérrez-Díez A, Gutiérrez-Ibañes E, Gallardo-López A, Samaniego-Lampón B, Lozano I, Melehi D, Portero-Portaz JJ, Elízaga J, Jiménez-Mazuecos J. The Feasibility and Safety of Ambulatory Percutaneous Coronary Interventions in Complex Lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:875-882. [PMID: 30639420 DOI: 10.1016/j.carrev.2018.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 12/05/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The safety and feasibility of ambulatory PCI has been demonstrated in selected patients with "simple" lesions, but it is not well known whether it could be applied in more "complex" scenarios. METHODS Main objective is to assess the feasibility and safety of ambulatory complex PCI. Prospective multicentre registry of 1047 consecutive patients planned for ambulatory trans-radial PCI. Outcomes in patients with "complex angioplasty" (CA group: 313 (30%)) were analysed and compared with those of "simple angioplasty" (SA group: 734, 70%). The feasibility (% of patients finally discharged) and safety (MACE at 24 h and at 1 month) were compared between groups. We also analyse admissions, visits to the emergency department and minor vascular complications. RESULTS Feasibility was higher for SA (80.6% vs. 63.6%, OR 1.89, 95% CI 1.52-2.35, p < 0.001). Ambulatory PCI was very safe in both groups. In CA no MACE occurred at 24 h (vs. 0.17% SA) or 30 days (vs. 0.68% in SA). There were also no differences in re-admissions, visits to the emergency department or minor vascular complications (there was a non-significant tendency to higher rate of radial occlusion at 1 month in the CA group, 5.5% vs. 2.7%, p: 0.07). CONCLUSIONS The feasibility of ambulatory PCI in selected patients with complex lesions is lower than in simple lesions, however when it is possible, it is as safe as in selected patients with simple lesions.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Iñigo Lozano
- Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - Driss Melehi
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | - Jaime Elízaga
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | |
Collapse
|
25
|
Safety of Same-Day Discharge after Percutaneous Coronary Intervention with Orbital Atherectomy. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:573-576. [PMID: 30224311 DOI: 10.1016/j.carrev.2018.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 08/31/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Severely calcified lesions present many challenges to percutaneous coronary intervention (PCI). Orbital atherectomy (OA) aids vessel preparation and treatment of severely calcified coronary lesions. Same-day discharge (SDD) after PCI has numerous advantages including cost savings and improved patient satisfaction. The aim of this study is to evaluate the safety of SDD among patients treated with OA in a real-world setting. METHODS This was a single-center retrospective analysis of patients undergoing OA. In-hospital and 30-day outcomes were assessed for major adverse cardiac events (MACE), device-related events and hospital readmissions. RESULTS There were 309 patients treated with OA of whom 94 had SDD (30.4%). Among SDD patients, there were no acute procedural complications and all patients were safely discharged on the day of the procedure. MACE at 30 days occurred in 1 patient (1.06%) due to major bleeding in the setting of a gastric arteriovenous malformation. There were 8 patients with unplanned 30-day readmissions (8.5%). CONCLUSION SDD after OA in patients with heavily calcified lesions appears to be safe, with low rates of adverse events and readmissions in select patients. In patients with SDD treated with OA, unplanned readmission occurred at a similar rate to the statewide average 30-day PCI readmission rate. Larger studies are needed to confirm the safety of this treatment paradigm and the potential cost savings.
Collapse
|
26
|
Biasco L, Pedrazzini GB, Araco M, Petracca F, Del Monte D, Sürder D, Bomio F, Berto MB, Montrasio G, Del Bufalo A, Pasotti E, Moccetti T, Moccetti M. Evaluation of a protocol for same-day discharge after radial lounge monitoring in a southern Swiss referral percutaneous coronary intervention centre. J Cardiovasc Med (Hagerstown) 2018; 18:590-595. [PMID: 28319532 DOI: 10.2459/jcm.0000000000000519] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of the study was to retrospectively evaluate safety and patient satisfaction of same-day discharge after elective radial coronary angiography/percutaneous coronary intervention (PCI) after the implementation of a radial lounge facility. METHODS All patients admitted to our radial lounge with a planned same-day discharge after an uncomplicated coronary angiography/PCI, having a co-living caregiver, were day enrolled in the study. Rates of same-day discharge, unplanned overnight stay, and in-hospital and first complications [death, myocardial infarction (MI), unplanned coronary angiography, access site hematoma, bleedings requiring hospitalization] were analysed; satisfaction was also evaluated through a questionnaire. RESULTS From February 2015 to January 2016, 312 patients with a mean age of 66.6 ± 10.8 years were admitted to the radial lounge (coronary angiography, n = 232; PCIs, n = 80). Of them, 245 (78.5%) were discharged the same day. Mean radial lounge monitoring was 6:35 h (interquartile range 5:30-7:30 h). No episodes of death/MI/unplanned coronary angiography were observed both in same-day discharged and postponed patients. Reasons to postpone discharge were: PCI deemed to need prolonged monitoring in 31, patient's preference in 14, femoral shift in 13, surgery in four, chest pain in four, and bleeding in one. At day 1, 11 access site hematoma and one hospitalization for access site bleeding were reported. Patients reported complete satisfaction in 97% of cases. Unplanned overnight stay was common among PCIs patients (RR 6.2, 95% CI 3.9-9.9, P < 0.001). CONCLUSION A low rate of minor complications was observed in elective radial coronary angiography and PCIs showing the feasibility and safety of the development of an institutional protocol for same-day discharge after the implementation of a radial lounge facility.
Collapse
Affiliation(s)
- Luigi Biasco
- Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Implementing Same Day Discharge Following Percutaneous Coronary Intervention: A Process Evaluation. J Nurs Care Qual 2018; 34:54-60. [PMID: 29912023 DOI: 10.1097/ncq.0000000000000337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The safety and effectiveness of same day discharge (SDD) following percutaneous coronary intervention are well demonstrated; however, the uptake of this model of care is low. PURPOSE The aim was to examine the effectiveness of implementing SDD using a process evaluation methodology. METHODS This study was undertaken in a cardiac services department of a tertiary teaching hospital in southeast Queensland, Australia. It was anticipated before the implementation that 120 patients could be discharged the same day in a 6 months' time period. Patient selection process and guideline adherence were assessed along with patients' and relatives' satisfaction. RESULTS During implementation, 22 patients were discharged home the same day. It was found that staff did not follow the guideline consistently, with an overall adherence of 77.3%. CONCLUSION The uptake of SDD was low in this implementation. The study is important as it provides direction for future improvement both in the criteria and the implementation process.
Collapse
|
28
|
Webner C. Discharging a Patient After a Percutaneous Coronary Intervention. Crit Care Nurse 2018; 38:80-81. [PMID: 29858199 DOI: 10.4037/ccn2018945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Cynthia Webner
- Cynthia Webner is a cardiac clinical nurse nurse practitioner, educator, and specialist, consultant in Northeast Ohio.
| |
Collapse
|
29
|
Goel PK, Menon A, Mullasari AS, Valaparambil AK, Pinto B, Pahlajani D, Gunasekaran S, Trehan VK, Abhaichand RK, Chugh SK, Hiremath MS. Transradial access for coronary diagnostic and interventional procedures: Consensus statement and recommendations for India: Advancing Complex CoronariES Sciences through TransRADIAL intervention in India - ACCESS RADIAL™: Clinical consensus recommendations in collaboration with Cardiological Society of India (CSI). Indian Heart J 2018; 70:922-933. [PMID: 30580867 PMCID: PMC6306363 DOI: 10.1016/j.ihj.2018.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 03/14/2018] [Indexed: 02/07/2023] Open
Abstract
Radial access for cardiac catheterization and intervention in India has been growing steadily over the last decade with favorable clinical outcomes. However, its usage by interventional cardiologists varies greatly among Indian operators and hospitals due to large geographic disparities in health care delivery systems and practice patterns. It also remains unclear whether the advantages, as well as limitations of transradial (TR) intervention (as reported in the western literature), are applicable to developing countries like India or not. An evidence-based review involving various facets of radial procedure for cardiac catheterization, including practical, patient-related and technical issues was conducted by an expert committee that formed a part of Advancing Complex CoronariES Sciences through TransRADIAL intervention (ACCESS RADIAL™) Advisory Board. Emerging challenges in redefining TR management based on evidence supporting practices were discussed to formulate these final recommendations through consensus.
Collapse
Affiliation(s)
- Pravin K Goel
- Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), India.
| | - Ajit Menon
- Department of Cardiology, Lilavati Hospital & Research Centre, India.
| | | | | | - Brian Pinto
- Department of Cardiology, Holy Family Hospital, India.
| | - Dev Pahlajani
- Department of Cardiology, Beach Candy Hospital, India.
| | | | | | | | | | - M S Hiremath
- Department of Cardiology, Ruby Hall Clinic, India.
| |
Collapse
|
30
|
Seto AH, Shroff A, Abu-Fadel M, Blankenship JC, Boudoulas KD, Cigarroa JE, Dehmer GJ, Feldman DN, Kolansky DM, Lata K, Swaminathan RV, Rao SV. Length of stay following percutaneous coronary intervention: An expert consensus document update from the society for cardiovascular angiography and interventions. Catheter Cardiovasc Interv 2018; 92:717-731. [DOI: 10.1002/ccd.27637] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 03/23/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Arnold H. Seto
- Department of Medicine; Long Beach Veterans Affairs Healthcare System, Long Beach, California
| | - Adhir Shroff
- Department of Medicine; University of Illinois at Chicago, Chicago, Illinois
| | - Mazen Abu-Fadel
- Department of Internal Medicine, Section of Cardiovascular Medicine; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - James C. Blankenship
- Department of Cardiology, Section of Interventional Cardiology; Geisinger Medical Center, Danville, Pennsylvania
| | | | - Joaquin E. Cigarroa
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Gregory J. Dehmer
- Department of Medicine (Cardiology Division) Texas A&M University College of Medicine; Scott & White Medical Center; Temple Texas
| | - Dmitriy N. Feldman
- New York-Presbyterian Hospital; Weill Cornell Medical College; New York New York
| | - Daniel M. Kolansky
- Cardiovascular Medicine Division; University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kusum Lata
- Sutter Tracy Community Hospital, Sutter Medical Network, Tracy, California
| | | | - Sunil V. Rao
- Division of Cardiology; Duke Clinical Research Institute, Durham, North Carolina
| |
Collapse
|
31
|
Abstract
PURPOSE OF REVIEW The evolution of cardiac catheterization has led to the development of well-refined, more effective, and safer devices that allow cardiovascular interventionalists to deliver high-quality percutaneous interventions (PCI). Transradial PCI (TRI) has gained more popularity in the USA over the past 10 years, and as experience and volume of TRI grow, studies adopting same day radial PCI protocols have emerged and are showing promising results. We sought to review the current literature on TRI and same day discharge (SDD). RECENT FINDINGS This literature review was performed to evaluate the studies that were published over the last 17 years regarding TRI and SDD. A literature search using PubMed, Cochran database, Google Scholar, and Embase was performed for studies evaluating TRI and SDD from January 1, 2000, to August 1, 2017. Observational studies, randomized clinical trials, meta-analyses, and consensus statements were included in our review. We used the following terms in our search: "same day," "same day discharge," "outpatient," and "ambulatory radial PCI." Articles with data pertinent to the subject matter were included. We did not limit our searches to specific journals. The available literature supports SDD for selected radial PCI patients. The advancement in PCI devices and pharmacology has enhanced the safety of post-PCI disposition leading to the evolution from traditional overnight stays to the development of same day discharge programs. We conclude that outpatient TRI for appropriately selected patients will be the standard of care in the future. This will lead to increased patient satisfaction, improved hospital throughput, and reduced hospital costs, without increased procedural complications.
Collapse
Affiliation(s)
- Ali Elfandi
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, 07960, USA
| | - Jordan G Safirstein
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, 07960, USA.
| |
Collapse
|
32
|
Amin AP, Crimmins-Reda P, Miller S, Rahn B, Caruso M, Pierce A, Dennis B, Pendegraft M, Sorensen K, Kurz HI, Lasala JM, Zajarias A, Bach RG, Kulkarni H, Singh J. Novel Patient-Centered Approach to Facilitate Same-Day Discharge in Patients Undergoing Elective Percutaneous Coronary Intervention. J Am Heart Assoc 2018; 7:JAHA.117.005733. [PMID: 29449273 PMCID: PMC5850176 DOI: 10.1161/jaha.117.005733] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Same‐day discharge (SDD) after elective percutaneous coronary intervention is safe, less costly, and preferred by patients, but it is usually performed in low‐risk patients, if at all. To increase the appropriate use of SDD in more complex patients, we implemented a “patient‐centered” protocol based on risk of complications at Barnes‐Jewish Hospital. Methods and Results Our objectives were as follows: (1) to evaluate time trends in SDD; (2) to compare (a) mortality, bleeding, and acute kidney injury, (b) patient satisfaction, and (c) hospital costs by SDD versus no SDD (NSDD); and (3) to compare SDD eligibility by our patient‐centered approach versus Society for Cardiovascular Angiography and Interventions guidelines. Our patient‐centered approach was based on prospectively identifying personalized bleeding, mortality, and acute kidney injury risks, with a personalized safe contrast limit and mitigating those risks. We analyzed Barnes‐Jewish Hospital's National Cardiovascular Data Registry CathPCI Registry data from July 1, 2009 to September 30, 2015 (N=1752). SDD increased rapidly from 0% to 77% (P<0.001), independent of radial access. Although SDD patients were comparable to NSDD patients, SDD was not associated with adverse outcomes (0% mortality, 0% bleeds, and 0.4% acute kidney injury). Patient satisfaction was high with SDD. Propensity score–adjusted costs were $7331 lower/SDD patient (P<0.001), saving an estimated $1.8 million annually. Only 16 patients (6.95%) met the eligibility for SDD by Society for Cardiovascular Angiography and Interventions guidelines, implying our patient‐centered approach markedly increased SDD eligibility. Conclusions With a patient‐centered approach, SDD rapidly increased and was safe in 75% of patients undergoing elective percutaneous coronary intervention, despite patient complexity. Patient satisfaction was high, and hospital costs were lower. Patient‐centered decision making to facilitate SDD is an important opportunity to improve the value of percutaneous coronary intervention.
Collapse
Affiliation(s)
- Amit P Amin
- Cardiovascular Division, Washington University School of Medicine, St Louis, MO .,Center for Value and Innovation, Washington University School of Medicine, St Louis, MO.,Barnes-Jewish Hospital, St Louis, MO
| | - Patricia Crimmins-Reda
- Center for Value and Innovation, Washington University School of Medicine, St Louis, MO.,Barnes-Jewish Hospital, St Louis, MO
| | | | - Brandon Rahn
- Center for Value and Innovation, Washington University School of Medicine, St Louis, MO.,Barnes-Jewish Hospital, St Louis, MO
| | - Mary Caruso
- Center for Value and Innovation, Washington University School of Medicine, St Louis, MO.,Barnes-Jewish Hospital, St Louis, MO
| | | | - Brandy Dennis
- Cardiovascular Division, Washington University School of Medicine, St Louis, MO.,Center for Value and Innovation, Washington University School of Medicine, St Louis, MO
| | - Marissa Pendegraft
- Cardiovascular Division, Washington University School of Medicine, St Louis, MO.,Center for Value and Innovation, Washington University School of Medicine, St Louis, MO
| | - Katrine Sorensen
- Cardiovascular Division, Washington University School of Medicine, St Louis, MO
| | - Howard I Kurz
- Cardiovascular Division, Washington University School of Medicine, St Louis, MO.,Barnes-Jewish Hospital, St Louis, MO
| | - John M Lasala
- Cardiovascular Division, Washington University School of Medicine, St Louis, MO.,Barnes-Jewish Hospital, St Louis, MO
| | - Alan Zajarias
- Cardiovascular Division, Washington University School of Medicine, St Louis, MO.,Barnes-Jewish Hospital, St Louis, MO
| | - Richard G Bach
- Cardiovascular Division, Washington University School of Medicine, St Louis, MO.,Barnes-Jewish Hospital, St Louis, MO
| | | | - Jasvindar Singh
- Cardiovascular Division, Washington University School of Medicine, St Louis, MO.,Barnes-Jewish Hospital, St Louis, MO
| |
Collapse
|
33
|
Feasibility and safety of outpatient cardiac catheterization with intracoronary acetylcholine provocation test. Heart Vessels 2018; 33:846-852. [DOI: 10.1007/s00380-018-1139-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 02/09/2018] [Indexed: 11/25/2022]
|
34
|
Abstract
BACKGROUND Overnight observation is the standard of care for uncomplicated elective percutaneous coronary intervention (PCI). However, same-day discharge (SDD) is reportedly safe using predetermined criteria and patient risk categories. Characteristics of patients with SDD have not yet been described. OBJECTIVE The purpose of this study was to describe the phenotype of patients appropriate for SDD after PCI without predetermined criteria and patient risk categories. METHODS Analysis of PCI registry data was conducted on patients (n = 2174) who underwent elective and nonelective PCI between January 2012 and June 2014. Preliminary analysis included descriptive statistics, t tests, and χ tests. All variables were analyzed using random forest plot to determine importance of predictors of SDD followed by confirmatory logistic regression. RESULTS Random forest plot indicated 6 predictors of SDD. Confirmatory logistic regression using a model with all 6 predictors indicated that the model was able to distinguish between patients with SDD and overnight observation after PCI and was statistically significant (χ(7.12, N = 2174) = 511.12, P < .005). Strongest predictors of SDD were stable angina (odds ratio, 5.93 [95% confidence interval, 1.316-26.712]; P = .020) followed by non-ST elevation myocardial infarction/high-risk unstable angina (odds ratio, 1.66 [95% confidence interval, 1.239-2.225]; P = .001). Readmission within 24 hours of SDD after PCI was low at 0.91%. CONCLUSIONS Age, access site, complexity, and number of lesions stented did not preclude SDD. A broader range of patients, particularly patients in higher risk categories (non-ST elevation myocardial infarction and unstable angina), are candidates for SDD.
Collapse
|
35
|
Seguridad y factibilidad de la intervención coronaria percutánea ambulatoria en pacientes seleccionados: datos de un registro multicéntrico español. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.09.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
36
|
Koutouzis M, Karatasakis A, Brilakis ES, Agelaki M, Maniotis C, Dimitriou P, Lazaris E. Feasibility and safety of same-day discharge after complex percutaneous coronary intervention using forearm approach. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:245-249. [DOI: 10.1016/j.carrev.2017.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 01/29/2017] [Accepted: 02/02/2017] [Indexed: 11/30/2022]
|
37
|
Din JN, Snow TM, Rao SV, Klinke WP, Nadra IJ, Della Siega A, Robinson SD. Variation in practice and concordance with guideline criteria for length of stay after elective percutaneous coronary intervention. Catheter Cardiovasc Interv 2017; 90:715-722. [DOI: 10.1002/ccd.26992] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 12/20/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Jehangir N. Din
- Victoria Heart Institute Foundation; Victoria British Columbia Canada
- Dorset Heart Centre, Royal Bournemouth Hospital; Bournemouth United Kingdom
| | - Thomas M. Snow
- Dorset Heart Centre, Royal Bournemouth Hospital; Bournemouth United Kingdom
| | - Sunil V. Rao
- Duke Clinical Research Institute; Durham North Carolina
| | - W. Peter Klinke
- Victoria Heart Institute Foundation; Victoria British Columbia Canada
| | - Imad J. Nadra
- Victoria Heart Institute Foundation; Victoria British Columbia Canada
- Royal Jubilee Hospital; Victoria British Columbia Canada
| | - Anthony Della Siega
- Victoria Heart Institute Foundation; Victoria British Columbia Canada
- Royal Jubilee Hospital; Victoria British Columbia Canada
| | - Simon D. Robinson
- Victoria Heart Institute Foundation; Victoria British Columbia Canada
- Royal Jubilee Hospital; Victoria British Columbia Canada
| |
Collapse
|
38
|
Safety and Feasibility of Outpatient Percutaneous Coronary Intervention in Selected Patients: A Spanish Multicenter Registry. ACTA ACUST UNITED AC 2017; 70:535-542. [PMID: 28254362 DOI: 10.1016/j.rec.2017.01.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 09/26/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES The exponential increase in coronary interventions plus the generalization of the radial approach represent the ideal scenario for starting outpatient angioplasty programs with the aim of reducing the costs while maintaining safety. This article reports data from a multicenter Spanish registry on fully ambulatory transradial angioplasty in selected patients for the first time. METHODS Prospective registry of elective outpatient transradial-ulnar angioplasty in patients with stable coronary disease. Patients were discharged the same day and were followed up at 24hours and 30 days. Safety and feasibility were analyzed. RESULTS Of the 723 patients included (76% male; age, 66.6±10.5 years), 533 (73.7%) were finally discharged after 4 to 12hours of surveillance. Among the remaining 190 (26.7%) patients, the most common reason for hospitalization was clinical instability after the procedure (60.5%). Independent predictors of admission were a history of peripheral artery disease, a higher baseline creatinine level, ad hoc performance of the procedure, and multivessel disease. At 24hours, there was 1 major adverse event in 1 patient (0.19%), who required hospitalization for major bleeding not related to vascular access. At 30 days, there were 3 major adverse events (0.56%): 1 subacute stent thrombosis, 1 revascularization of a vessel other than the treated vessel, and 1 minor stroke. Eight patients (1.5%) required admission at 30 days. CONCLUSIONS The application of an outpatient transradial-ulnar angioplasty program with discharge after 4 to 12 hours' surveillance is safe and feasible in well-selected patients.
Collapse
|
39
|
Graziano FD, Banga S, Busman DK, Muthusamy P, Wohns DH. Barriers to Early Discharge after Elective Percutaneous Coronary Intervention (BED PCI): A Single-Center Study. Indian Heart J 2016; 69:217-222. [PMID: 28460770 PMCID: PMC5414966 DOI: 10.1016/j.ihj.2016.11.323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 11/23/2016] [Indexed: 12/02/2022] Open
Abstract
Objective To identify patient characteristics and procedural factors that may play a role in hindering same-day discharge (SDD) practices. Background Multiple studies have shown the safety and cost effectiveness of SDD following elective percutaneous coronary intervention (PCI), but factors that hinder SDD practices have not been thoroughly studied. Material and Methods A retrospective comparative analysis of elective PCI patients who had an overnight stay (OS) (n = 345) vs. SDD patients (n = 222) was conducted to identify significant differences between the two groups in baseline patient characteristics, procedural, and postprocedural factors. Results Comparing OS to SDD patients, OS patients had a lower prevalence of radial access (20.29% vs. 39.64%, P < 0.0001); a higher incidence of suboptimal angiographic results (14.49% vs. 1.80%, P = 0.0027); CRCL values lower than 60 mL/min (26.38% vs. 15.32%, P = 0.0019); and greater femoral vascular site hemostasis with manual compression (69.09% vs. 36.57%, P = 0.0027). OS patients received larger sheath sizes (P = 0.0209), more bivalirudin (45.80% vs. 36.70%) and glycoprotein IIb/IIIa inhibitors (5.51% vs. 2.25%), but less heparin (51.30% vs. 53.21%). Chest pain (8.12% vs. 0.92%, P = 0.0042) and vascular access site concerns (20.58% vs. 0%, P = 0.0027) were more common among OS patients. Conclusions Pre-, peri-, and post-procedural factors play a role in SDD eligibility. Understanding factors that limit as well as those that facilitate SDD may enable institutions to establish or enhance a SDD program.
Collapse
Affiliation(s)
| | - Sandeep Banga
- Frederik Meijer Heart & Vascular Institute, Grand Rapids, MI, USA; University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
| | - Denise K Busman
- Frederik Meijer Heart & Vascular Institute, Grand Rapids, MI, USA; Spectrum Health, Grand Rapids, MI, USA
| | | | - David H Wohns
- Frederik Meijer Heart & Vascular Institute, Grand Rapids, MI, USA; Spectrum Health, Grand Rapids, MI, USA
| |
Collapse
|
40
|
Naidu SS, Aronow HD, Box LC, Duffy PL, Kolansky DM, Kupfer JM, Latif F, Mulukutla SR, Rao SV, Swaminathan RV, Blankenship JC. SCAI expert consensus statement: 2016 best practices in the cardiac catheterization laboratory: (Endorsed by the cardiological society of india, and sociedad Latino Americana de Cardiologia intervencionista; Affirmation of value by the Canadian Associatio. Catheter Cardiovasc Interv 2016; 88:407-23. [DOI: 10.1002/ccd.26551] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 03/17/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Srihari S. Naidu
- Division of Cardiology, Winthrop University Hospital, Mineola, New York
| | - Herbert D. Aronow
- Warren Alpert Medical School of Brown University, Cardiovascular Institute, Providence, RI
| | | | | | - Daniel M. Kolansky
- Cardiovascular Medicine Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joel M. Kupfer
- University of Illinois School of Medicine-Peoria, Peoria, IL
| | - Faisal Latif
- University of Oklahoma and VA Medical Center, Oklahoma City, OK
| | - Suresh R. Mulukutla
- University of Pittsburgh and VA Pittsburgh Healthcare System, Pittsburgh, PA
| | | | - Rajesh V. Swaminathan
- Weill Cornell Medical College, New York-Presbyterian Hospital, Greenberg Division of Cardiology, New York, NY
| | | |
Collapse
|
41
|
Toerper MF, Flanagan E, Siddiqui S, Appelbaum J, Kasper EK, Levin S. Cardiac catheterization laboratory inpatient forecast tool: a prospective evaluation. J Am Med Inform Assoc 2015; 23:e49-57. [PMID: 26342217 DOI: 10.1093/jamia/ocv124] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 07/11/2015] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To develop and prospectively evaluate a web-based tool that forecasts the daily bed need for admissions from the cardiac catheterization laboratory using routinely available clinical data within electronic medical records (EMRs). METHODS The forecast model was derived using a 13-month retrospective cohort of 6384 catheterization patients. Predictor variables such as demographics, scheduled procedures, and clinical indicators mined from free-text notes were input to a multivariable logistic regression model that predicted the probability of inpatient admission. The model was embedded into a web-based application connected to the local EMR system and used to support bed management decisions. After implementation, the tool was prospectively evaluated for accuracy on a 13-month test cohort of 7029 catheterization patients. RESULTS The forecast model predicted admission with an area under the receiver operating characteristic curve of 0.722. Daily aggregate forecasts were accurate to within one bed for 70.3% of days and within three beds for 97.5% of days during the prospective evaluation period. The web-based application housing the forecast model was used by cardiology providers in practice to estimate daily admissions from the catheterization laboratory. DISCUSSION The forecast model identified older age, male gender, invasive procedures, coronary artery bypass grafts, and a history of congestive heart failure as qualities indicating a patient was at increased risk for admission. Diagnostic procedures and less acute clinical indicators decreased patients' risk of admission. Despite the site-specific limitations of the model, these findings were supported by the literature. CONCLUSION Data-driven predictive analytics may be used to accurately forecast daily demand for inpatient beds for cardiac catheterization patients. Connecting these analytics to EMR data sources has the potential to provide advanced operational decision support.
Collapse
Affiliation(s)
- Matthew F Toerper
- Johns Hopkins Department of Emergency Medicine, 1830 East Monument Street, Suite 6-100, Baltimore, MD 21287, USA Johns Hopkins Health System Operations Integration, 600 N. Wolfe Street, Administration Bldg. Suite 420, Baltimore, MD 21287, USA
| | - Eleni Flanagan
- Johns Hopkins Heart and Vascular Institute, 600 N. Wolfe Street, The Johns Hopkins Hospital, Baltimore, MD 21287, USA
| | - Sauleh Siddiqui
- Department of Civil Engineering, Johns Hopkins Systems Institute, Johns Hopkins University, 3400 N Charles Street, Baltimore, MD 21218, USA Department of Applied Mathematics and Statistics, Johns Hopkins Systems Institute, Johns Hopkins University, 3400 N Charles Street, Baltimore, MD 21218, USA
| | - Jeff Appelbaum
- Johns Hopkins Health System Operations Integration, 600 N. Wolfe Street, Administration Bldg. Suite 420, Baltimore, MD 21287, USA
| | - Edward K Kasper
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Scott Levin
- Johns Hopkins Department of Emergency Medicine, 1830 East Monument Street, Suite 6-100, Baltimore, MD 21287, USA Johns Hopkins Health System Operations Integration, 600 N. Wolfe Street, Administration Bldg. Suite 420, Baltimore, MD 21287, USA
| |
Collapse
|
42
|
Quintavalle C, Anselmi CV, De Micco F, Roscigno G, Visconti G, Golia B, Focaccio A, Ricciardelli B, Perna E, Papa L, Donnarumma E, Condorelli G, Briguori C. Neutrophil Gelatinase–Associated Lipocalin and Contrast-Induced Acute Kidney Injury. Circ Cardiovasc Interv 2015; 8:e002673. [DOI: 10.1161/circinterventions.115.002673] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Cristina Quintavalle
- From the Department of Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy (C.Q., E.P., G.C.); Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy (C.V.A., L.P.); Humanitas Research Hospital, Rozzano, Italy (C.V.A., L.P.); Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy (F.D.M., G.V., B.G., A.F., B.R., C.B.); Institute for Endocrinology and Experimental Oncology, National Research Council,
| | - Chiara Viviani Anselmi
- From the Department of Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy (C.Q., E.P., G.C.); Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy (C.V.A., L.P.); Humanitas Research Hospital, Rozzano, Italy (C.V.A., L.P.); Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy (F.D.M., G.V., B.G., A.F., B.R., C.B.); Institute for Endocrinology and Experimental Oncology, National Research Council,
| | - Francesca De Micco
- From the Department of Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy (C.Q., E.P., G.C.); Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy (C.V.A., L.P.); Humanitas Research Hospital, Rozzano, Italy (C.V.A., L.P.); Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy (F.D.M., G.V., B.G., A.F., B.R., C.B.); Institute for Endocrinology and Experimental Oncology, National Research Council,
| | - Giuseppina Roscigno
- From the Department of Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy (C.Q., E.P., G.C.); Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy (C.V.A., L.P.); Humanitas Research Hospital, Rozzano, Italy (C.V.A., L.P.); Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy (F.D.M., G.V., B.G., A.F., B.R., C.B.); Institute for Endocrinology and Experimental Oncology, National Research Council,
| | - Gabriella Visconti
- From the Department of Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy (C.Q., E.P., G.C.); Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy (C.V.A., L.P.); Humanitas Research Hospital, Rozzano, Italy (C.V.A., L.P.); Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy (F.D.M., G.V., B.G., A.F., B.R., C.B.); Institute for Endocrinology and Experimental Oncology, National Research Council,
| | - Bruno Golia
- From the Department of Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy (C.Q., E.P., G.C.); Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy (C.V.A., L.P.); Humanitas Research Hospital, Rozzano, Italy (C.V.A., L.P.); Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy (F.D.M., G.V., B.G., A.F., B.R., C.B.); Institute for Endocrinology and Experimental Oncology, National Research Council,
| | - Amelia Focaccio
- From the Department of Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy (C.Q., E.P., G.C.); Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy (C.V.A., L.P.); Humanitas Research Hospital, Rozzano, Italy (C.V.A., L.P.); Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy (F.D.M., G.V., B.G., A.F., B.R., C.B.); Institute for Endocrinology and Experimental Oncology, National Research Council,
| | - Bruno Ricciardelli
- From the Department of Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy (C.Q., E.P., G.C.); Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy (C.V.A., L.P.); Humanitas Research Hospital, Rozzano, Italy (C.V.A., L.P.); Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy (F.D.M., G.V., B.G., A.F., B.R., C.B.); Institute for Endocrinology and Experimental Oncology, National Research Council,
| | - Enzo Perna
- From the Department of Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy (C.Q., E.P., G.C.); Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy (C.V.A., L.P.); Humanitas Research Hospital, Rozzano, Italy (C.V.A., L.P.); Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy (F.D.M., G.V., B.G., A.F., B.R., C.B.); Institute for Endocrinology and Experimental Oncology, National Research Council,
| | - Laura Papa
- From the Department of Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy (C.Q., E.P., G.C.); Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy (C.V.A., L.P.); Humanitas Research Hospital, Rozzano, Italy (C.V.A., L.P.); Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy (F.D.M., G.V., B.G., A.F., B.R., C.B.); Institute for Endocrinology and Experimental Oncology, National Research Council,
| | - Elvira Donnarumma
- From the Department of Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy (C.Q., E.P., G.C.); Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy (C.V.A., L.P.); Humanitas Research Hospital, Rozzano, Italy (C.V.A., L.P.); Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy (F.D.M., G.V., B.G., A.F., B.R., C.B.); Institute for Endocrinology and Experimental Oncology, National Research Council,
| | - Gerolama Condorelli
- From the Department of Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy (C.Q., E.P., G.C.); Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy (C.V.A., L.P.); Humanitas Research Hospital, Rozzano, Italy (C.V.A., L.P.); Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy (F.D.M., G.V., B.G., A.F., B.R., C.B.); Institute for Endocrinology and Experimental Oncology, National Research Council,
| | - Carlo Briguori
- From the Department of Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy (C.Q., E.P., G.C.); Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy (C.V.A., L.P.); Humanitas Research Hospital, Rozzano, Italy (C.V.A., L.P.); Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy (F.D.M., G.V., B.G., A.F., B.R., C.B.); Institute for Endocrinology and Experimental Oncology, National Research Council,
| |
Collapse
|
43
|
Safety and Efficacy of Same-Day Discharge Following Elective Percutaneous Coronary Intervention, Including Evaluation of Next Day Troponin T Levels. Heart Lung Circ 2015; 24:368-76. [DOI: 10.1016/j.hlc.2014.11.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 11/06/2014] [Accepted: 11/11/2014] [Indexed: 12/22/2022]
|
44
|
Aydin A, Gurol T, Soylu O, Dagdeviren B. Early ambulatory discharge is safe and feasible after transradial coronary interventions. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VESSELS 2014; 3:60-63. [PMID: 29450172 PMCID: PMC5801437 DOI: 10.1016/j.ijchv.2014.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 03/08/2014] [Indexed: 06/08/2023]
Abstract
BACKGROUND At present, there are no definite criteria for selecting patients eligible for same-day discharge after percutaneous coronary interventions (PCI). With rapid ambulation and reduced vascular complication rates, transradial PCI have many features that favorably reduce costs and hospital stay. This study aimed to demonstrate the possibility of early ambulatory discharge following transradial percutaneous coronary interventions. METHODS 254 consecutive patients undergoing transradial PCI (elective, urgent, and emergent) at our center was observed during hospital stay. Patient demographics, angiographic characteristics, post-procedural complications, and timing of these post-procedural events were recorded. RESULTS A total of 336 lesions were treated among 299 vessels with 277 stents. One hundred fifty-two (45.2%) lesions were Type C. There were 26 chronic total occlusions (CTO). One hundred fifty-five (61%) patients were discharged on the same day after the procedure. 24 complications (12.6%) occurred and were divided into three groups according to occurrence time. 13 (54.2%) occurred within the first 2 h and 11 (45.8%) occurred after the 24-hour period. No complications were observed between the 2nd and 24th hours. CONCLUSIONS Same-day discharge with a 2-hour observation period is safe and feasible after successful transradial PCI in appropriate patients. Although a minor number of complications occurred, these did not occur between the 2nd and 24th hours. Same-day discharge after successful transradial PCI could be an alternative for better utilization of resources.
Collapse
Affiliation(s)
- Alper Aydin
- Corresponding author at: Bahcesehir University School of Medicine, Department of Cardiology, Goztepe Medical Park Hastanesi, 23 Nisan Sok No 17 Goztepe Istanbul, Turkey. Tel.: + 90 542 5855519Corresponding author at: Bahcesehir University School of MedicineDepartment of CardiologyGoztepe Medical Park Hastanesi23 Nisan Sok No 17, GoztepeTel.: + 90 542 5855519IstanbulTurkey
| | | | | | | |
Collapse
|
45
|
|
46
|
Clinical and economic evaluation of ambulatory endovascular treatment of peripheral arterial occlusive lesions. Ann Vasc Surg 2013; 28:137-43. [PMID: 24183403 DOI: 10.1016/j.avsg.2013.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 06/11/2013] [Accepted: 06/13/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Ambulatory management of patients is an alternative to conventional hospitalization. In this study we evaluate the results of a prospective cohort study of patients receiving ambulatory endovascular treatment for peripheral arterial lesions. METHODS From June 2008 to October 2010, ambulatory management was proposed for endovascular treatment of peripheral arterial lesions. An arterial closure device (Angio-Seal(®); St. Jude Medical) was used. For ambulatory treatment, patients were prohibited from driving a vehicle at discharge, had to be accompanied the first night after the procedure, had to live <1 hour from a medical facility, had to be reachable by telephone the day after the intervention, and had to remain hospitalized in the event of a complication. The principal criterion was morbimortality at 1 month. Secondary criteria were clinical improvement, patency, complications related to the arterial closure, and costs evaluation at 1 month. RESULTS Forty-five patients were included and 50 ambulatory procedures were carried out. The patients presented with claudication (92%) or a critical ischemia (8%) of the lower extremities. All procedures were carried out by femoral puncture (retrograde in 94% and anterograde in 6% of the cases). The patients presented with iliac (68%) and femoropopliteal (64%) lesions. Lesions included stenoses (70%), thromboses (16%), and intrastent restenoses (14%). The rate of failure of ambulatory hospitalization was 16% (n = 8) without a serious undesirable event: 2 patients were hospitalized after a surgical conversion for iliac rupture and disinsertion of stent; 3 patients developed a hematoma during the intervention at the point of puncture; and in 3 cases the system of percutaneous closure failed. The mean duration of hospitalization was 1.36 ± 1.33 days. At 1 month, clinical improvement was observed in 97.5% of cases, with a primary patency of 100%. No perioperative rehospitalization or puncture site complications were observed. Ambulatory management made it possible to save 42 days of hospitalization, with associated costs of 10,971€, compared with conventional hospitalization. The additional costs related to use of the Angio-Seal amounted to 7427€. CONCLUSION Ambulatory endovascular treatment of patients presenting with peripheral arterial lesions is reliable and effective and may contribute to savings in healthcare spending.
Collapse
|
47
|
HODKINSON EMILYC, RAMSEWAK ADESH, MURPHY JOHNCONLETH, SHAND JAMESA, MCCLELLAND ANTHONYJ, MENOWN IANBA, HANRATTY COLMG, SPENCE MARKS, WALSH SIMONJ. An Audit of Outcomes After Same-Day Discharge Post-PCI in Acute Coronary Syndrome and Elective Patients. J Interv Cardiol 2013; 26:570-7. [DOI: 10.1111/joic.12065] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
| | - ADESH RAMSEWAK
- Cardiology Department; Belfast Health and Social Care Trust; Belfast UK
| | | | - JAMES A. SHAND
- Cardiology Department; Belfast Health and Social Care Trust; Belfast UK
| | - ANTHONY J. MCCLELLAND
- Craigavon Cardiac Centre; Craigavon Area Hospital, Southern Health and Social Care Trust; Craigavon UK
| | - IAN B. A. MENOWN
- Craigavon Cardiac Centre; Craigavon Area Hospital, Southern Health and Social Care Trust; Craigavon UK
| | - COLM G. HANRATTY
- Cardiology Department; Belfast Health and Social Care Trust; Belfast UK
| | - MARK S. SPENCE
- Cardiology Department; Belfast Health and Social Care Trust; Belfast UK
| | - SIMON J. WALSH
- Cardiology Department; Belfast Health and Social Care Trust; Belfast UK
| |
Collapse
|
48
|
Laskey WK, Ricciardi MJ. 30-day readmission rate following percutaneous coronary intervention: much more than a binary variable. JACC Cardiovasc Interv 2013; 6:245-6. [PMID: 23517835 DOI: 10.1016/j.jcin.2012.12.119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 12/07/2012] [Indexed: 11/18/2022]
|
49
|
Brayton KM, Patel VG, Stave C, de Lemos JA, Kumbhani DJ. Same-Day Discharge After Percutaneous Coronary Intervention. J Am Coll Cardiol 2013; 62:275-85. [DOI: 10.1016/j.jacc.2013.03.051] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 02/27/2013] [Accepted: 03/13/2013] [Indexed: 12/29/2022]
|
50
|
Kim M, Muntner P, Sharma S, Choi JW, Stoler RC, Woodward M, Mann DM, Farkouh ME. Assessing patient-reported outcomes and preferences for same-day discharge after percutaneous coronary intervention: results from a pilot randomized, controlled trial. Circ Cardiovasc Qual Outcomes 2013; 6:186-92. [PMID: 23481528 DOI: 10.1161/circoutcomes.111.000069] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Same-day discharge after percutaneous coronary intervention (PCI) may be safe for some patients. Few data are available on patient-reported outcomes and preferences for same-day discharge after PCI. METHODS AND RESULTS Between March 2008 and March 2010, a total of 298 patients undergoing elective PCI via femoral access at 2 medical centers (Mount Sinai Hospital, New York, NY, and Baylor Medical Center, Dallas, TX) were randomized to same-day (n=150) or next-day (n=148) discharge. The primary outcome was high patient coping during the 7 days after discharge defined as scores <20 on the validated postdischarge coping difficulty scale. Safety outcomes, clopidogrel adherence, and patient preferences were secondary outcomes. Before discharge, patients randomized to same-day and next-day discharge were similar with respect to sociodemographic and clinical characteristics. High-coping ability, assessed 7 days after PCI, was present for 79% of patients randomized to same-day discharge and for 77% of patients randomized to next-day discharge. The difference in high coping ability, 2 (95% confidence interval, -7 to 11), did not cross the noninferiority threshold of -12% (P<0.001 that same-day discharge is not noninferior to next-day discharge). At 30 days after PCI, clopidogrel adherence, physician and emergency room visits, and hospitalization were similar in the 2 randomization groups. In addition, 80% and 68% of those randomized to same-day and next-day discharge, respectively, stated they would prefer same-day discharge if they were to have another PCI procedure. CONCLUSIONS Same-day discharge after PCI was associated with patient-reported and clinical outcomes similar to those of next-day discharge and was preferred by most patients.
Collapse
Affiliation(s)
- Michael Kim
- Department of Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA
| | | | | | | | | | | | | | | |
Collapse
|