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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.
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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
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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] [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.
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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
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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.
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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.
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Koutouzis M, Liontou C, Xenogiannis I, Tajti P, Tsiafoutis I, Lazaris E, Oikonomidis N, Kontopodis E, Rangan B, Brilakis E. Same day discharge after chronic total occlusion interventions: A single center experience. Catheter Cardiovasc Interv 2021; 98:1232-1239. [PMID: 33048434 DOI: 10.1002/ccd.29320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To assess the feasibility and safety of same day discharge (SDD) after chronic total occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND CTO PCI has been associated with higher complication rates and procedural and hospitalization costs. Shortening post-PCI hospitalization length not only increases the patients' comfort but at the same time it consists an important part of cost reduction policies. METHODS We retrospectively compared the 30-day outcomes of patients who underwent CTO PCI at the Red Cross Hospital, Greece between January 2016 and June 2019 and underwent SDD versus non-SDD. Major adverse cardiovascular events (MACE) were defined as the composite of death, myocardial infarction, urgent repeat target vessel revascularization, tamponade, and stroke. RESULTS A total of 173 patients (mean age 63.7 ± 8.9 years) were included, of whom 51 (30%) underwent SDD. SDD patients were less likely to have diabetes mellitus (51 vs. 31%, p = .015), arterial hypertension (89 vs. 67%, p < .001), and acute coronary syndrome presentation (39.7 vs. 21.6%, p = .022), compared with non-SDD patients. Forearm access was used in all SDD patients and in 83% of the non-SDD patients. The 30-day incidence of MACE was 0% in the SDD group and 1.6% in the non-SDD group. Multivariable analysis showed that diabetes mellitus and longer procedural time were associated with lower probability of SDD (OR: 0.34, 95% CI: 0.15, 0.73 and OR: 0.29, 95% CI: 0.12, 0.71, respectively). CONCLUSIONS SDD appears to be feasible and safe in selected patients undergoing an uncomplicated CTO PCI through forearm approach.
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Affiliation(s)
| | | | - Iosif Xenogiannis
- Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Peter Tajti
- Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | | | | | | | | | - Bavana Rangan
- Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Emmanouil Brilakis
- Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
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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] [MESH Headings] [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.
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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.
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Khaled S, Jaha N, Shalaby G, Niazi AK, Alhazmi F, Alqasimi H, Ruzaizah RA, Haddad M, Alsabri M, Kufiah H. Early discharge (within 24-72 h) in low-risk AMI patients treated with PCI: feasibility and safety-Hajj study. Egypt Heart J 2020; 72:55. [PMID: 32894368 PMCID: PMC7477056 DOI: 10.1186/s43044-020-00095-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 08/27/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Shortening of the hospital stay in patients admitted with the diagnosis of acute myocardial infarction (AMI) has been observed within the last decades. Our center is the only cardiac center in the region providing tertiary care facility and hence receives all AMI patients deemed suitable for invasive assessment and management and this leads to huge required demand. Our aim is to assess feasibility and safety of the early discharge of selected proportion of AMI patients. RESULT Out of 557 of patients presented with AMI and treated with percutaneous coronary intervention (PCI), 310 (56%) were discharged early. Men patients and pilgrims were more prevalent among the early discharge group. Early discharged patients had significantly less comorbidities compared to the other group of patients. Moreover, they presented mainly with ST-elevation myocardial infarction (P = 0.04) and treated more with primary percutaneous coronary intervention (PPCI) (P = 0.04). They had favorable coronary anatomy (P = 0.01 and 0.02 for left main and multi-vessel coronary artery disease, respectively), better hospital course, and higher left ventricular ejection fraction compared to non-early discharged patients (P = 0.006 and < 0.001 for pulmonary edema and left ventricular ejection fraction post myocardial infarction). Follow-up of those early discharged patients were promising as majority of them were asymptomatic (95%) and did well post-discharge. CONCLUSION Our study demonstrated data that support safety of early discharge in a carefully selected group of AMI patients. Early but safe discharge may have a huge impact on increasing bed availability, reducing hospital costs, and improving patient's satisfaction.
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Affiliation(s)
- Sheeren Khaled
- Benha University, Benha, Egypt
- King Abdullah Medical City, Muzdallfa Road, Makkah, Saudi Arabia
| | - Najeeb Jaha
- King Abdullah Medical City, Muzdallfa Road, Makkah, Saudi Arabia
| | - Ghada Shalaby
- King Abdullah Medical City, Muzdallfa Road, Makkah, Saudi Arabia
- Zagazig University, Zagazig, Egypt
| | | | - Faisal Alhazmi
- King Faisal Specialist hospital and research center, King Abdullah Medical City, Muzdallfa Road, Makkah, Saudi Arabia
| | - Hadeel Alqasimi
- College of Medicine, Umm Al Qura University, Makkah City, Makkah 24353 Saudi Arabia
| | - Rahaf Abu Ruzaizah
- College of Medicine, Umm Al Qura University, Makkah City, Makkah 24353 Saudi Arabia
| | - Mryam Haddad
- College of Medicine, Umm Al Qura University, Makkah City, Makkah 24353 Saudi Arabia
| | - Mroj Alsabri
- College of Medicine, Umm Al Qura University, Makkah City, Makkah 24353 Saudi Arabia
| | - Heba Kufiah
- College of Medicine, Umm Al Qura University, Makkah City, Makkah 24353 Saudi Arabia
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Taxiarchi P, Martin GP, Kinnaird T, Curzen N, Ahmed J, Ludman P, De Belder M, Shoaib A, Rashid M, Kontopantelis E, Mamas MA. Contributors to the Growth of Same Day Discharge After Elective Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2020; 13:e008458. [DOI: 10.1161/circinterventions.119.008458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Financial pressures for reducing hospitalization costs have driven to a move toward same day discharge (SDD) following uncomplicated percutaneous coronary intervention. The UK healthcare system has transitioned to predominantly SDD for elective percutaneous coronary intervention. This study aimed to examine patient’s clinical, procedural, and institutional characteristics that are associated with the increased adoption of SDD adoption over time in the United Kingdom and determine whether these vary by region.
Methods:
The data were derived from the British Cardiovascular Intervention Society including all the elective percutaneous coronary intervention from 2007 to 2014 in the United Kingdom. We structured 8 meaningful groups of variables, and their relative importance was obtained by decomposing the R
2
in each study year.
Results:
The relative importance of Strategic Health Authorities was substantially higher than all other factors every year, with some reduction over time, from 49.2% (95% CI, 45.4%–52.4%) in 2007 to 43.4% (95% CI, 39.9%–46.6%) in 2014. Center volume followed with 8.95% (95% CI, 7.0%–10.9%) to 19.8% (95% CI, 16.7%–22.4%). Between patients’ clinical and procedural characteristics, pharmacology and access site had the highest relative importance values, from 14.3% (95% CI, 12.1%–16.4%) to 7.1% (95% CI, 5.5%–8.8%) and from 3.6% (95% CI, 2.3%–5.1%) to 11.8% (95% CI, 9.4%–14.3%), respectively. Relative importance of different groups varied differently across Strategic Health Authorities.
Conclusions:
Growth of SDD was mainly associated with regional characteristics, while subcontributors varied substantially between different regions. Standardized guidelines would provide more homogenous adoption of SDD nationally. This analysis might be of wider interest in healthcare systems slower in SDD adoption.
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Affiliation(s)
- Paraskevi Taxiarchi
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, United Kingdom (P.T., G.P.M.)
| | - Glen P. Martin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, United Kingdom (P.T., G.P.M.)
| | - Tim Kinnaird
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.)
- Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, University of Keele (T.K., A.S., M.R., M.A.M.)
| | - Nick Curzen
- Coronary Research Group, University Hospital Southampton, Faculty of Medicine, University of Southampton, United Kingdom (N.C.)
| | - Javed Ahmed
- Department of Cardiology, Freeman Hospital, Newcastle, United Kingdom (J.A.)
| | - Peter Ludman
- Cardiology Department, Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.)
| | - Mark De Belder
- Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.D.B.)
| | - Ahmad Shoaib
- Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, University of Keele (T.K., A.S., M.R., M.A.M.)
- Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, United Kingdom (A.S., M.R., M.A.M.)
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, University of Keele (T.K., A.S., M.R., M.A.M.)
- Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, United Kingdom (A.S., M.R., M.A.M.)
| | - Evangelos Kontopantelis
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, United Kingdom (E.K., M.A.M.)
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, University of Keele (T.K., A.S., M.R., M.A.M.)
- Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, United Kingdom (A.S., M.R., M.A.M.)
- Department of Medicine (Cardiology), Thomas Jefferson University Hospital, Philadelphia, PA (M.A.M.)
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, United Kingdom (E.K., M.A.M.)
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Liew S, Dinh D, Liew D, Brennan A, Duffy S, Reid C, Lefkovits J, Stub D. Prevalence, Outcomes and Cost Implications of Patients Undergoing Same Day Discharge After Elective Percutaneous Coronary Intervention in Australia. Heart Lung Circ 2019; 29:e185-e193. [PMID: 31791887 DOI: 10.1016/j.hlc.2019.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/16/2019] [Accepted: 09/13/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite international growth in the use of same day percutaneous coronary intervention (PCI), its widespread use remains limited. This study sought to determine the prevalence, clinical outcomes and cost implications of same day discharge (SDD) amongst Australian patients undergoing elective PCI. METHODS This is a retrospective, observational cohort study of patients who underwent elective PCI in Victoria between January 2014 and December 2017. Data from this study was obtained from the Victorian Cardiac Outcomes Registry (VCOR). The primary outcome measured was the incidence of 30-day major adverse cardiac events (MACE) and secondary outcomes included in hospital complications and 30-day readmissions, between SDD patients and those observed as inpatients overnight (ON). Propensity score matching for key clinical factors were used to compare both groups. RESULTS We studied 18,101 patients, with a mean age of 68±11years and 13,935 (77%) were male. The rate of SDD was 586 (3.2%) and 17,515 (96.8%) patients stayed in hospital overnight. Radial access was performed in 393 (67.1%) and 7,967 (45.5%) among SDD and ON patients respectively (p<0.001). At 30 days, unplanned cardiac re-hospitalisation occurred in 9.6% (n=56) amongst SDD and 11.6%, (n=2,033) amongst ON patients (p=0.173). Propensity matching highlighted SDD to be non-inferior to overnight, with no significant difference in 30-day MACE (0.5%, 95% CI: 0.34, 1.35) but SDD was associated with reduced average length of stay by 2.06 days (95% CI: 1.94, 2.19). We observed substantial hospital variation for SDD from 0% to 16.6% of elective PCI procedures. CONCLUSIONS Same day discharge after elective PCI is performed infrequently in Victoria. Despite this, SDD appears to be safe and feasible. Given significant benefits in cost and bed utilisation, a more consistent use of SDD could markedly improve the value of PCI care in Australia.
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Affiliation(s)
- Stephanie Liew
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Vic, Australia
| | - Diem Dinh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Angela Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Stephen Duffy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Vic, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Christopher Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; School of Public Health, Curtin University, Perth, WA, Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Vic, Australia; Department of Cardiology, Western Health, Melbourne, Vic, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Vic, Australia.
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Mason PJ, Shah B, Tamis-Holland JE, Bittl JA, Cohen MG, Safirstein J, Drachman DE, Valle JA, Rhodes D, Gilchrist IC. An Update on Radial Artery Access and Best Practices for Transradial Coronary Angiography and Intervention in Acute Coronary Syndrome: A Scientific Statement From the American Heart Association. Circ Cardiovasc Interv 2019; 11:e000035. [PMID: 30354598 DOI: 10.1161/hcv.0000000000000035] [Citation(s) in RCA: 311] [Impact Index Per Article: 62.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Transradial artery access for percutaneous coronary intervention is associated with lower bleeding and vascular complications than transfemoral artery access, especially in patients with acute coronary syndromes. A growing body of evidence supports adoption of transradial artery access to improve acute coronary syndrome-related outcomes, to improve healthcare quality, and to reduce cost. The purpose of this scientific statement is to propose and support a "radial-first" strategy in the United States for patients with acute coronary syndromes. This document also provides an update to previously published statements on transradial artery access technique and best practices, particularly as they relate to the management of patients with acute coronary syndromes.
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10
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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.
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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
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11
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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.
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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
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12
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Rymer JA, Rao SV. The Current State of Transradial Access: A Perspective on Transradial Outcomes, Learning Curves, and Same-Day Discharge. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2018. [DOI: 10.15212/cvia.2017.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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13
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Rymer JA, Patel MR. Mature Technology for Mature Patients. JACC Cardiovasc Interv 2018; 11:889-891. [DOI: 10.1016/j.jcin.2018.03.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/27/2018] [Indexed: 12/01/2022]
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14
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Gilchrist IC. If Only the Doctor Will Let Me Go Home: Same Day Discharge after PCI. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 18:231-232. [PMID: 28577793 DOI: 10.1016/j.carrev.2017.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ian C Gilchrist
- Professor of Medicine, Pennsylvania State University, College of Medicine, Heart & Vascular Institute, Hershey, PA, 717-531-5888.
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15
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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.
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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.
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16
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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.
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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
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17
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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]
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18
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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.
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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
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19
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Abdul Jabbar A, Mufti O, Sabol A, Markert R, White B, Broderick G. Arterial Access in Patients With De Novo Acute Coronary Syndrome Undergoing Coronary Angiography. Angiology 2016; 68:360-365. [PMID: 27252244 DOI: 10.1177/0003319716652277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bleeding is a major limitation of antithrombotic therapy among invasively managed patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs). Randomized clinical trials have generally failed to favor either the femoral or the radial arterial approach for coronary angiography or intervention in NSTE-ACS. In 561 hospitalized patients with a new diagnosis of NSTE-ACS referred for coronary angiography, 364 and 197 patients underwent the femoral and the radial approach, respectively. Femoral and radial access did not differ in bleeding complications in the first 72 hours (8 of 364 or 2.2% vs 8 of 197 or 4.1%, P = .21), duration of hospitalization (4.67 ± 5.02 vs 4.51 ± 4.81, P = .28) nor in-hospital mortality (0.8% vs 0.5%, P = .67). Contrast volume was higher for femoral versus radial cases (204 ± 119 vs 168 ± 104, P < .001). In patients with de novo NSTE-ACS without prior cardiac bypass, radial and femoral arterial access did not differ in instances of bleeding within the first 72 hours postoperatively, length of hospital stay, or in-hospital mortality. Less contrast was used in radial cases, which may represent an advantage for patients with renal insufficiency.
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Affiliation(s)
- Ali Abdul Jabbar
- 1 Cardiology Division, Department of Internal Medicine, Wright State University, Boonshoft School of Medicine, Dayton, OH, USA.,2 Division of Cardiovascular Medicine, Department of Medicine, The University of Toledo Medical Center, Toledo, OH, USA
| | - Omar Mufti
- 1 Cardiology Division, Department of Internal Medicine, Wright State University, Boonshoft School of Medicine, Dayton, OH, USA
| | - Angeline Sabol
- 1 Cardiology Division, Department of Internal Medicine, Wright State University, Boonshoft School of Medicine, Dayton, OH, USA
| | - Ronald Markert
- 1 Cardiology Division, Department of Internal Medicine, Wright State University, Boonshoft School of Medicine, Dayton, OH, USA
| | - Bryan White
- 1 Cardiology Division, Department of Internal Medicine, Wright State University, Boonshoft School of Medicine, Dayton, OH, USA
| | - George Broderick
- 1 Cardiology Division, Department of Internal Medicine, Wright State University, Boonshoft School of Medicine, Dayton, OH, USA
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20
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Chen Y, Marshall A, Lin F. Implementation Strategies for Same Day Discharge Post Percutaneous Coronary Intervention: An Integrative Review. Worldviews Evid Based Nurs 2016; 13:371-379. [PMID: 27171576 DOI: 10.1111/wvn.12163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Same day discharge following percutaneous coronary intervention has emerged worldwide to enhance discharge efficiency and decrease length of stay. However, uptake of this practice is variable and strategies to support its implementation have not been examined. RESEARCH QUESTION Among patients who undergo nonurgent percutaneous coronary intervention, what components are included in and which strategies are used to facilitate the implementation of same day discharge in clinical practice? METHODS An integrative review was conducted. Keywords including same day discharge, outpatient, percutaneous coronary intervention, outpatient coronary stenting were used to search databases including Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica dataBase, Cochrane, and Medline between 1990 and 2014. Data were extracted and summarized specific to: (a) components of same day discharge, (b) patient selection, and (c) strategies used to implement same day discharge. RESULTS Nineteen articles were included that provided information about implementation strategies for same day discharge. Variability was identified in how same day discharge was operationalized, how patients were selected, and the strategies that were used to implement same day discharge. Culture, patient preference, and acceptance of same day discharge were important for its implementation. Guideline or protocol, physical environment, champion, education, audit or feedback, and team building were all found to be important strategies in implementing same day discharge. LINKING EVIDENCE TO ACTION The results of this integrative review inform our understanding of how same day discharge is operationalized and what strategies can be used to implement same day discharge. The findings of the review highlight that there is a need for more research examining implementation strategies in a detailed manner that can assist others to introduce and sustain same day discharge in routine practice.
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Affiliation(s)
- Yingyan Chen
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Southport, QLD, Australia.
| | - Andrea Marshall
- Professor of Acute and Complex Care Nursing, School of Nursing and Midwifery; NHMRC Centre of Research Excellence in Nursing Interventions for Hospitalized Patients (NCREN), Menzies Health Institute Queensland; Gold Coast Hospital and Health Service, Nursing and Midwifery Education and Research Unit, all at Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | - Frances Lin
- Program Director, Senior Lecturer, School of Nursing and Midwifery, and Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
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21
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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]
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Abstract
The transradial route for coronary angiography is a growing trend in the United States. Nurse practitioners (NPs) are an essential part of the preprocedural assessment and management of patients. This article will outline the benefits and risks of transradial access as well as methods for NPs to assess arterial hand circulation.
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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.
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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
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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
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Amin AP, House JA, Safley DM, Chhatriwalla AK, Giersiefen H, Bremer A, Hamon M, Baklanov DV, Aluko A, Wohns D, Mathias DW, Applegate RA, Cohen DJ, Marso SP. Costs of Transradial Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2013; 6:827-34. [DOI: 10.1016/j.jcin.2013.04.014] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 04/12/2013] [Accepted: 04/25/2013] [Indexed: 12/29/2022]
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Abdelaal E, Bertrand OF. Transradial PCI and same day discharge: a winning team? Catheter Cardiovasc Interv 2013; 81:24-5. [PMID: 23281082 DOI: 10.1002/ccd.24760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 11/16/2012] [Indexed: 11/12/2022]
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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]
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Amoroso G. Transradial approach for percutaneous coronary interventions: the future is now. Interv Cardiol 2013. [DOI: 10.2217/ica.13.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abdelaal E, Rao SV, Gilchrist IC, Bernat I, Shroff A, Caputo R, Costerousse O, Pancholy SB, Bertrand OF. Same-Day Discharge Compared With Overnight Hospitalization After Uncomplicated Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2013; 6:99-112. [DOI: 10.1016/j.jcin.2012.10.008] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 09/26/2012] [Accepted: 10/26/2012] [Indexed: 12/29/2022]
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Muthusamy P, Busman DK, Davis AT, Wohns DH. Assessment of clinical outcomes related to early discharge after elective percutaneous coronary intervention. Catheter Cardiovasc Interv 2012; 81:6-13. [DOI: 10.1002/ccd.24537] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 06/24/2012] [Indexed: 12/29/2022]
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