The impact of short hospital stay on prognosis after acute myocardial infarction: An analysis from the ACSIS database

[Multimorbidity as a predictor for inpatient admission in clinical emergency and acute medicine : Single-center cluster analysis]

BACKGROUND

Parallel to demographic trends, an increase of multimorbid patients in emergency and acute medicine is prominent. To define easily applicable criteria for the necessity of inpatient admission, a hierarchical cluster analysis was performed.

METHODS

In a retrospective, single-center study data of n = 35,249 emergency cases (01/2016-05/2018) were statistically analyzed. Multimorbidity (MM) was defined by at least five ICD-10-GM diagnoses resulting from treatment. A hierarchical cluster analysis was performed for those diagnoses initially summarized into 112 diagnosis subclusters to determine specific clusters of in- and outpatient cases.

RESULTS

Hospital admission was determined in 81.2% of all ED patients (n = 28,633); 54.7% of inpatients (n = 15,652) and 0.97% of outpatient cases (n = 64) met the criteria for multimorbidity and the age difference between them was highly significant (68.7/60.8 years; p < 0.001). Using a hierarchical cluster analysis, 13 clusters with different diagnoses were identified for inpatient multimorbid patients (MP) and 7 clusters with primarily hematological malignancies for outpatient MP. The length of stay in the ED of inpatient MP was more than twice as long (max. 8.3 h) as for outpatient MP (max. 3.2 h.).

CONCLUSIONS

The combination of diagnoses typical for MM were characterized as clusters in this study. In contrast to single or combined single diagnoses, the statistically determined characterization of clusters allows for a significantly more accurate prediction of ED patients' disposition as well as for economic process allocation.

Circadian Variations and Associated Factors in Patients with Ischaemic Heart Disease

Circadian rhythms have been identified in cardiovascular diseases, and cardiovascular risk factors can modify the circadian rhythm. The purpose of this study was to describe the onset of ischaemic heart disease symptomatology in relation to the date and time, the day of the week of presentation, the season, AMI location and severity and the level of influence of individual patient characteristics in a retrospective cross-sectional study involving 244 ischaemic heart disease patients from the intensive care unit of La Ribera Hospital (Spain). The onset of pain was more frequent in the morning, the season with the highest frequency of ischaemic events was winter, and the lowest incidence was during weekends. Regarding the severity of ischaemic heart disease, the circadian rhythm variables of weekdays vs. weekends and seasons did not show a significant association. The length of hospital stay was associated with the onset of pain in the afternoon. The onset of pain at night was associated with the subendocardial location of the infarction. In conclusion, living in a Mediterranean country, the Spanish population showed a circadian pattern of AMI, where the onset of pain has an influence on AMI location and on the length of hospital stay and is the same in patients with different individual risk factors.

The impact of short hospital stay on prognosis after acute myocardial infarction: An analysis from the ACSIS database

BACKGROUND

Current evidence regarding the optimal length of hospital stay (LOS) following myocardial infarction (MI) is limited. This study aimed to examine LOS policy for MI patients and to assess the safety of early discharge.

METHODS

A prospective observational study that included patients with STEMI and NSTEMI enrolled in the Acute Coronary Syndrome Israeli Survey (ACSIS) during the years 2000-2016. Patients were divided into three subgroups according to their LOS: <3 days (short-LOS), 3-6 days (intermediate-LOS) and >6 days (long-LOS). We compared baseline characteristics, management strategies and clinical outcomes at 30 days and 1 year in these groups.

RESULTS

Ten thousand four hundred and fifty eight patients were enrolled in the study. The LOS of MI patients gradually decreased over time. Short-LOS and intermediate-LOS patients had similar clinical characteristics while patients in the long-LOS group were older with more co-morbidity. There was no difference in the clinical outcomes, including re-MI, arrhythmias, 30 days MACE, and 30 days mortality between the short-LOS and intermediate-LOS groups. However, the rate of re-hospitalizations was higher in the short-LOS group (20.9% vs. 17.8%, p = .004) without evidence of increased cardiovascular events. In multivariate analysis, the LOS did not predict either 30 days mortality (HR: 1.3; CI:0.45-5.48), nor MACE at 30 days (HR: 1.1; CI:0.79-1.56).

CONCLUSION

Our study suggests that an early discharge strategy of up to 3 days from admission is safe for low and intermediate-risk patients after both STEMI and NSTEMI. Nevertheless, this strategy is associated with an increased risk of potential avoidable readmission and there might be psychological and social factors that may warrant a longer stay.