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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] [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.
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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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Kumsa NB, Kelly TL, Roughead EE, Tavella R, Gillam MH. Temporal trends in percutaneous coronary intervention in Australia: A retrospective analysis from 2000-2021. Hellenic J Cardiol 2023:S1109-9666(23)00193-8. [PMID: 37863429 DOI: 10.1016/j.hjc.2023.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/27/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023] Open
Abstract
OBJECTIVE The aim of this study was to describe the trend in percutaneous coronary intervention (PCI) with insertion of a stent in Australia from 2000/01 to 2020/21 and investigate trends in same-day versus non-same-day discharge following PCI. A secondary aim was to compare the rate of coronary artery bypass grafting (CABG) with PCI procedures, while a third aim was to compare marked PCI trend changes with the PCI guidelines during the study period. BACKGROUND PCI with stent deployment is the most common form of interventional treatment for coronary artery disease, and its use has been expanding since 2000. However, there is a lack of descriptive studies of the national trend in Australia. METHODS All procedures for PCI and CABG were extracted across 21 years (2000/01 to 2020/21) from the Australian Institute of Health and Welfare data. Age-standardized rates were calculated using the Australian standard population as of June 2001. The ratio of PCI to CABG procedures was also calculated. Trends for PCI were stratified by age, gender, and same-day or overnight discharge episodes. Linear regression analysis was done to compare the age-standardized rates across different age categories. Segmented regression analysis was performed to ascertain the change in the age-standardized rates of PCI during the study period. Whether the changepoints in the trend were matched with guideline updates was also assessed. RESULTS There were 751 728 PCI procedures in persons aged 30 years and above between 2000/01 and 2020/21. The age-standardized rate for the study period showed that persons aged 60-74 years had a higher rate of procedures (102.7) compared to persons aged 30-59 years (81.3) and 75 years and older (61.8) (P < 0.001). There were two statistically significant changepoints in the overall trend; 2005/06 and 2013/14, matched with the change in PCI guidelines. Despite the lower number of procedures for same-day discharge episodes, there has been an increasing trend since 2014/15. More than two-thirds of all stenting procedures were the insertion of a single stent. PCI to CABG procedure ratio increased from 0.6 in 2000/01 to 1.8 in 2020/21. CONCLUSIONS There was a varying trend in the age-standardized rate of PCI with a peak in 2005/06. The trend appears to be stabilizing in the later part of the study period, but the rate for same-day discharge episodes showed an increasing trend after 2014/15. There is consistency with changepoints in the trend and updated PCI guideline recommendations. The ratio of PCI with insertion of a stent to CABG procedure increased substantially across the study period.
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Affiliation(s)
- Netsanet B Kumsa
- Clinical and Health Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Australia.
| | - Thu-Lan Kelly
- Clinical and Health Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Australia.
| | - Elizabeth E Roughead
- Clinical and Health Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Australia.
| | - Rosanna Tavella
- Faculty of Health and Medical Sciences, The University of Adelaide, Australia.
| | - Marianne H Gillam
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia.
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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.
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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
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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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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.
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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
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Wyffels E, Beles M, Baeyens A, Croeckaert K, De Potter T, Van Camp G, Collet C, Sonck J, Vanderheyden M, Bartunek J, Barbato E, Bermpeis K, Bertolone DT, Gallinoro E, Esposito G, Schoonjans G, Staelens F, Van Laer E, De Bruyne B. Same Day Discharge Strategy by Default in a Tertiary Catheterization Laboratory. Value Based Healthcare-Change in Practice. Health Policy 2023; 132:104826. [PMID: 37087953 DOI: 10.1016/j.healthpol.2023.104826] [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: 12/19/2022] [Revised: 03/29/2023] [Accepted: 04/16/2023] [Indexed: 04/25/2023]
Abstract
AIMS To assess the effects on outcomes and hospital revenues (societal cost) of a by default strategy of same day discharge (SDD) in patients undergoing a cardiac catheterization procedure in a Belgian Hospital. METHODS AND RESULTS Outcome and complete financial data were obtained in all consecutive patients with a cardiac catheterization performed in 2019 (n=5237) and in 2021 (n=5377). Patient-reported experience, patient satisfaction and Net promotor score were obtained prospectively for the SDD cohort in 2021. The proportion of patients receiving catheterization procedure in SDD increased from 28 to 44 % (p<0.001). This translates to the saving of 889 conventional hospitalizations in 2021. All-cause death and readmission rate remained unchanged (0,17% vs 0,15% (p=0,004); and 0,7% vs 1,8% (p>0,05)) in 2019 and 2021, respectively. Patients satisfaction top box score was 91% and the Net Promotor Score was 89,5. The by default SDD strategy was associated with reduction in in-hospital health care spending, on average 3206€ per procedure is saved. This means a 57% decrease in hospital revenues and translates into an important decrease in physician income. CONCLUSION Implementing a by default SDD cardiac catheterization strategy results in a reduction of societal cost, excellent patient satisfaction and unchanged clinical outcome. Yet, in the given context this approach negatively impacts hospital and physician revenues precluding the sustainability of such protocol.
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Affiliation(s)
- Eric Wyffels
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium.
| | - Monika Beles
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Ann Baeyens
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | | | - Tom De Potter
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Guy Van Camp
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Carlos Collet
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Jeroen Sonck
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Marc Vanderheyden
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Jozef Bartunek
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Emanuele Barbato
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Via S Pansini 5, 80131 Naples, Italy
| | | | - Dario Tino Bertolone
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Via S Pansini 5, 80131 Naples, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Via S Pansini 5, 80131 Naples, Italy
| | - Giuseppe Esposito
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Guy Schoonjans
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Frank Staelens
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Els Van Laer
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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Shah JA, Kumar R, Solangi BA, Khan KA, Ahmed T, Khowaja S, Ali G, Zehra M, Sial JA, Karim M, Saghir T, Qamar N. One-year major adverse cardiovascular events among same-day discharged patients after primary percutaneous coronary intervention at a tertiary care cardiac centre in Karachi, Pakistan: a prospective observational study. BMJ Open 2023; 13:e067971. [PMID: 37037620 PMCID: PMC10111899 DOI: 10.1136/bmjopen-2022-067971] [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] [Indexed: 04/12/2023] Open
Abstract
OBJECTIVE Knowledge regarding the short-term outcomes after same-day discharge (SDD) post primary percutaneous coronary intervention (PCI) is lacking. In this study, we evaluated 1-year major adverse cardiovascular events (MACE) among SDD patients after primary PCI. DESIGN 1-year follow-up analysis of a subset of patients from an existing prospective cohort study. SETTING Tertiary care cardiac hospital in Karachi, Pakistan. PARTICIPANTS Consecutive patients, from August 2019 to July 2020, with ST segment elevation myocardial infarction who had undergone primary PCI with SDD (within 24 hours) after the procedure by the treating physician and with at least one successful follow-up up to 1 year. OUTCOME MEASURE Cumulative MACE during follow-up at the intervals of 1 week, 1 month, 6 months and 1 year. RESULTS 489 patients were included, with a gender distribution of 83.2% (407) male patients and a mean age of 54.58±10.85 years. Overall MACE rate during the mean follow-up duration of 326.98±76.71 days was 10.8% (53), out of which 26.4% (14/53) events occurred within 6 months of discharge and the remaining 73.6% (39/53) occurred between 6 months and 1 year. MACE was significantly higher among patients with a Zwolle Risk Score (ZRS) ≥4 at baseline, with an incidence rate of 21.9% (16/73) vs 8.9% (37/416; p=0.001) in patients with ZRS≤3 (relative risk 2.88 (95% CI 1.5 to 5.5)). CONCLUSION A significant burden of short-term MACE was identified among SDD patients after primary PCI; most of these events occurred after 6 months of SDD, mainly among patients with ZRS≥4. A systematic risk assessment based on risk stratification modalities such ZRS could be a viable option for SDD patients with primary PCI.
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Affiliation(s)
- Jehangir Ali Shah
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Rajesh Kumar
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Bashir Ahmed Solangi
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Kamran Ahmed Khan
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Tarique Ahmed
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Sanam Khowaja
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Gulzar Ali
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Mehwish Zehra
- Department of Medicine, Jinnah Post Graduate Medical Centre, Karachi, Pakistan
| | - Jawaid Akbar Sial
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Musa Karim
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Tahir Saghir
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Nadeem Qamar
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
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Management and Outcomes in the Elderly with Non-ST-Elevation Acute Coronary Syndromes Admitted to Spoke Hospitals with No Catheterization Laboratory Facility. J Clin Med 2022; 11:jcm11206179. [PMID: 36294500 PMCID: PMC9605530 DOI: 10.3390/jcm11206179] [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] [Received: 07/21/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Contemporary guidelines advocate for early invasive strategy with coronary angiography in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). Still, the impact of an invasive strategy in older patients remains controversial and may be challenging in spoke hospitals with no catheterization laboratory (cath-lab) facility. Purpose: The purpose of this study was to analyse the characteristics and outcomes of patients ≥80 years old with NSTE-ACS admitted to spoke hospitals. Methods: Observational−retrospective study of all consecutive NSTE-ACS patients admitted to two spoke hospitals of our cardiology network, where a service strategy (same-day transfer between a spoke hospital and a hub centre with a cath-lab facility in order to perform coronary angiography) was available. Patients were followed up for 1 year after the admission date. Results: From 2013 to 2017, 639 patients were admitted for NSTE-ACS; of these, 181 (28%) were ≥80 years old (median 84, IQR 82−89) and represented the study cohort. When the invasive strategy was chosen (in 105 patients, or 58%), 98 patients (93%) were initially managed with a service strategy, whereas the remainder of the patients were transferred from the spoke hospital to the hub centre where they completed their hospital stay. Of the patients managed with the service strategy, a shift of strategy after the invasive procedure was necessary for 10 (10%). These patients remained in the hub centre, while the rest of the patients were sent back to the spoke hospitals, with no adverse events observed during the back transfer. The median time to access the cath-lab was 50 h (IQR 25−87), with 73 patients (70%) reaching the invasive procedure <72 h from hospital admission. A conservative strategy was associated with: older age, known CAD, clinical presentation with symptoms of LV dysfunction, lower EF, renal failure, higher GRACE score, presence of PAD and atrial fibrillation (all p < 0.03). At the 1-year follow-up, the overall survival was significantly higher in patients treated with an invasive strategy compared to patients managed conservatively (94% ± 2 vs. 54% ± 6, p < 0.001; HR: 10.4 [4.7−27.5] p < 0.001), even after adjustment for age, serum creatinine, known previous CAD and EF (adjusted HR: 2.0 [1.0−4.0]; p < 0.001). Conclusions: An invasive strategy may confer a survival benefit in the elderly with NSTE-ACS. The same-day transfer between a spoke hospital and a hub centre with a cath-lab facility (service strategy) is safe and may grant access to the cath-lab in a timely fashion, even for the elderly.
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Hyasat K, Femia G, Alzuhairi K, Ha A, Kamand J, Hasche E, Rajaratnam R, Lo S, Almafragy H, Liou K, Chiha J, Asrress K. Safety, Feasibility and Economic Analysis of Same Day Discharge Following Elective Percutaneous Coronary Intervention. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2022; 16:11795468221116852. [PMID: 36046181 PMCID: PMC9421009 DOI: 10.1177/11795468221116852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/04/2022] [Indexed: 11/16/2022]
Abstract
Background Advances in percutaneous coronary intervention (PCI) has made the possibility of facilitating same day discharge (SDD) of patients undergoing intervention. We sought to investigate the feasibility, safety and economic impact of such a service. Methods We retrospectively collected data on all patients undergoing outpatient PCI at our institution over a 12-month period. We included in-hospital and 30-day major adverse cardiac events (MACE), vascular complications, acute kidney injury and any re-hospitalisations. We analysed the cost effectiveness of SDD compared to overnight admission post PCI and staged PCI following diagnostic angiography. Results A total of 147 patients undergoing PCI with 129 patients deemed suitable for SDD (88%). Mean age was 65.7 years. Most patients had type C lesions (60.3%); including 4 chronic total occlusions (CTOs). At 30-day follow-up there were no MACE events (0%). There were 10 (7.8%) re-hospitalisations of which majority (70%) were non cardiac presentations. We also included cost analysis for an elective PCI with SDD, which equated to $2090 per patient (total of $269 610 for cohort). Elective PCI with an overnight admission was $4440 per patient (total of $572 760 for cohort), an additional $2350 per patient (total $303 150). Total cost of an angiogram followed by a staged PCI with an overnight stay was $4700 per patient (total $606 300). Conclusion SDD is safe and feasible in the majority of patients that have elective coronary angiography that require PCI. SDD leads to a significant reduction in total cost and hospital stay of patients undergoing elective PCI.
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Affiliation(s)
- Kais Hyasat
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia.,Department of Cardiology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Giuseppe Femia
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia.,Department of Cardiology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Karam Alzuhairi
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
| | - Andrew Ha
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
| | - Joseph Kamand
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
| | - Edmund Hasche
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
| | - Rohan Rajaratnam
- Department of Cardiology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Sidney Lo
- Department of Cardiology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Hamid Almafragy
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
| | - Kevin Liou
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
| | - Joseph Chiha
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
| | - Kaleab Asrress
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia.,Department of Cardiology, Liverpool Hospital, Liverpool, NSW, Australia
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11
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Hariri E, Kassas I, Hammoud MA, Hansra B, Akhter MW, Fisher DZ, Smith CS, Barringhaus KG. Same day discharge following non-elective PCI for non-ST elevation acute coronary syndromes. Am Heart J 2022; 246:125-135. [PMID: 34998967 DOI: 10.1016/j.ahj.2021.12.015] [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: 08/21/2021] [Revised: 12/20/2021] [Accepted: 12/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM Timing of discharge after percutaneous coronary intervention (PCI) is a crucial aspect of procedural safety and patient turnover. We examined predictors and outcomes of same-day discharge (SDD) after non-elective PCI for non-ST elevation acute coronary syndromes (NSTE-ACS) in comparison with next-day discharge (NDD). METHODS Baseline demographic, clinical, and procedural data were collected as were in-hospital outcomes and post-PCI length of stay (LOS) for all patients undergoing non-elective PCI for NSTE-ACS between 2011 and 2014 at a central tertiary care center. Thirty day and 1-year mortality and bleeding as well as 30-day readmission rates were determined from social security record and medical chart review. Logistic regression was performed to identify predictors of SDD, and propensity-matched analysis was done to examine the differences in outcomes between NDD and SDD. RESULTS Out of 2,529 patients who underwent non-elective PCI for NSTE-ACS from 2011 to 2014, 1,385 met the inclusion criteria (mean age = 63 years; 26% women) and were discharged either the same day of (N = 300) or the day after (N = 1,085) PCI. Thirty-day and one-year mortality and major bleeding rates were similar between the 2 groups. Logistic regression identified male sex, radial access, negative troponin biomarker status, and procedure start time as predictors of SDD. In propensity-matched analyses, there was no difference in 30-day mortality and readmission between SDD and NDD groups. CONCLUSIONS SDD after non-elective PCI for NSTE-ACS may be a reasonable alternative to NDD for selected low-risk patients with comparable mortality, bleeding, and readmission rates.
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Affiliation(s)
- Essa Hariri
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland OH
| | - Ibrahim Kassas
- Advocate Christ Medical Center/University of Illinois at Chicago, Oak Lawn, IL; Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Mazen Al Hammoud
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | - Barinder Hansra
- Division of Cardiology, Department of Medicine, UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA
| | - Mohammed W Akhter
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA; Division of Cardiovascular Medicine, Duke University School of Medicine, Durham, NC
| | - Daniel Z Fisher
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Craig S Smith
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Kurt G Barringhaus
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA; Division of Cardiology, Columbia VA Health Care System, University of South Carolina School of Medicine, PRISMA Health, Columbia, SC.
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12
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Rashedi S, Tavolinejad H, Kazemian S, Mardani M, Masoudi M, Masoudkabir F, Haghjoo M. Efficacy and safety of same-day discharge after atrial fibrillation ablation: A systematic review and meta-analysis. Clin Cardiol 2022; 45:162-172. [PMID: 35084049 PMCID: PMC8860483 DOI: 10.1002/clc.23778] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/29/2021] [Accepted: 01/04/2022] [Indexed: 12/17/2022] Open
Abstract
Conventionally, patients have been admitted overnight after atrial fibrillation (AF) catheter ablation. Several centers have recently adopted a same‐day discharge (SDD) protocol for patients undergoing AF catheter ablation. We aimed to systematically review the current evidence for the safety and efficacy of SDD after AF catheter ablation. A systematic search was performed in PubMed, Embase, Scopus, Web of Science, and the Cochrane library until August 21, 2021. The risk of bias was assessed with the “Methodological Index for Non‐Randomized Studies” (MINORS). The pooled efficacy rate of SDD protocol (defined as the proportion of patients discharged the same day of ablation among the patients who were planned for SDD) was calculated. Meanwhile, pooled major complication rates and early readmission or emergency department (ED) visit rates were evaluated in successful and planned SDD groups separately. Overall, 12 observational studies consisting of 18,065 catheter ablations were included, among which 7320 (40.52%) were discharged the same‐day after ablation. The pooled efficacy was 90.3% (95% confidence interval [CI] [82.7–96.0]). The major complication rates were 1.1% (95%CI [0.5–1.9]), and 0.7% (95% CI [0.0–3.1]) in planned SDD and successful SDD groups, respectively. In addition, readmission/ED visit rate were 3.0% (95%CI [0.9–6.1]), and 3.1% (95% CI [0.8–6.5]) in the same groups. There were no significant differences between planned SDD and overnight groups with respect to major complication rate (risk ratio = 0.70, 95%CI [0.35–1.42], p‐value = .369). The available data indicates that SDD after AF ablation is safe and efficient. Further prospective and randomized studies are warranted to elucidate the safety of SDD after AF ablation and develop a standardized SDD protocol.
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Affiliation(s)
- Sina Rashedi
- Department of Cardiac Electrophysiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Tavolinejad
- Department of Cardiac Electrophysiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Kazemian
- Department of Cardiac Electrophysiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahta Mardani
- Department of Cardiac Electrophysiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Masoudi
- Department of Cardiac Electrophysiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Masoudkabir
- Department of Cardiac Electrophysiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Haghjoo
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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13
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Sahashi Y, Kuno T, Tanaka Y, Passman R, Briasoulis A, Malik AH. The 30-day readmission rate of same-day discharge protocol following catheter ablation for atrial fibrillation: a propensity score-matched analysis from National Readmission Database. Europace 2021; 24:755-761. [PMID: 34904164 DOI: 10.1093/europace/euab296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/10/2021] [Indexed: 01/17/2023] Open
Abstract
AIMS The effectiveness and safety of same-day discharge (SDD) for catheter ablation (CA) for atrial fibrillation (AF) has not been fully elucidated using a large nationwide database. This study aimed to evaluate the all-cause readmission rates within 30-days among patients receiving CA for AF with an SDD protocol compared with a conventional overnight stay (ONS). METHODS AND RESULTS We performed a retrospective cohort study using the US Nationwide Readmission Database. The primary outcome was all-cause 30-day readmission following discharge in patients receiving CA and a secondary outcome was requiring total healthcare cost. A 1 : 3 propensity score matching was conducted to compare the safety and efficacy within both SDD and ONS group. Among 30 776 patients [mean 67.2 ± 11.4 years, 12 590 female (41.5%)] who received CA from 2016 through 2018, 440 (1.42%) patients were discharged on the same-day following CA (SDD group), and the remaining 30 336 patients stayed at least one night in the hospital (ONS group). A propensity score analysis generated 1751 matched pairs (440 in the SDD group; 1311 in the ONS group). The 30-day readmission following discharge was not significantly higher in the SDD group than the ONS group (SDD vs. ONS: 12.7% vs. 9.7%; hazard ratio: 1.17, 95% confidence interval: 0.76-1.81, P = 0.47). Healthcare cost was significantly higher in the ONS group ($25 237 ± 14 036 vs. $30 749 ± 16 383; P < 0.01). CONCLUSION In this nationwide database study, there was no significant difference in the all-cause 30-day readmission following SDD for CA compared with ONS.
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Affiliation(s)
- Yuki Sahashi
- Department of Cardiovascular Medicine, Gifu Heart Center, 4-14-4, Yabutaminami, Gifu 500-8384, Japan.,Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan.,Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Japan
| | - Toshiki Kuno
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA.,Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Yoshihiro Tanaka
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center for Arrhythmia Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rod Passman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center for Arrhythmia Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alexandros Briasoulis
- Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Aaqib H Malik
- Division of Cardiology, Westchester Medical Center, Valhalla, NY, USA
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14
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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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15
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Economic impact And SafetY of Same-Day Discharge following percutaneous coronary intervention: A tertiary care centre experience from northern India (EASY-SDD). CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40:71-77. [PMID: 34776354 DOI: 10.1016/j.carrev.2021.11.005] [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: 08/13/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The literature about the safety and feasibility of same-day discharge (SDD) following complex percutaneous coronary intervention (PCI) and in acute coronary syndrome (ACS) is scarce. The economic impact of SDD has not been evaluated in this geographical region. We in the present study evaluated the safety, feasibility, and economic impact of SDD following PCI at a tertiary care centre of north India. METHODS It was a single-centre, non-randomized, prospective study, in which all consecutive PCI patients during the study period of 15 months were evaluated for SDD using a "patient-centred" approach. The patients who were discharged on the next calendar day were included in the next day discharge (NDD) group. The baseline demographic data including coronary risk factors, clinical presentation, and management details were noted for all patients. All patients were followed up for 6 weeks. The Indian health system is only partially insured, hence most of the expendable costs are borne by patients. In the present study, we computed the total societal expenditure of each PCI which includes both the health system costs and the expenditure borne by the patients. A standardized tool and bottoms up costing method were used for recording out-of-pocket expenditure (OOPE) by the patients and health care expenditure respectively. RESULTS Out of a total of 675 PCI patients, 617 patients were enrolled in the study, and 132/617 (21.39%) patients were discharged the same day. Sixty-five % of patients (86/132) in the SDD cohort and 70% of patients (337/485) in the NDD cohort presented with ACS. Baseline characteristics in the two cohorts were identical. A higher syntax score, greater number of stents, and longer stented segment predicted the NDD. The mean length of stay after PCI in patients with SDD and NDD was 8.71 ± 2.48 and 21.76 ± 2.42 h, respectively. In the SDD group, there were no readmissions or adverse events after discharge till 6 weeks of follow-up. The total mean cost of PCI (health care system and OOPE) for SDD and NDD was Indian Rupees (INR) 129,322.14 [United States dollar (US$) 1810.51] and INR 165500.71 [US$ 2317.01] respectively. An amount of INR 36178.57 (health system cost: INR 10242.76 and OOPE: INR 25935.71 was saved for each SDD. Besides 100 cardiac unit bed days including 85 intensive cardiac care bed days were saved with 21% SDD in the present cohort. CONCLUSION Post PCI SDD is safe and feasible in selected ACS/chronic stable angina patients using the "patient-centred" approach. Besides, decreasing OOPE for the patients, SDD also helps in the efficient use of scarce health system resources.
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16
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Chan CMC, Lee MKY, Chan AKC, Hui ML, Li PWC. Changing the model of care during the COVID-19 pandemic: Same-day discharge of patients undergoing elective invasive cardiac procedures in Hong Kong. Heart Lung 2021; 50:919-925. [PMID: 34428737 PMCID: PMC8349687 DOI: 10.1016/j.hrtlng.2021.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 11/25/2022]
Abstract
Background Despite an evidence-based protocol to facilitate same-day discharge (SDD) of patients undergoing elective intracoronary procedures, overnight hospitalization remains a routine practice. Objectives This study aimed to determine the frequency of SDD after intracoronary procedures among patients treated before and during the COVID-19 pandemic, and identify factors predictive of a decision for SDD. Methods This retrospective cohort study (N = 680) was based on registry data of a cardiac ambulatory center. Results The frequency of SDD was significantly higher in 2020 relative to 2019 (p < 0.001). No complication were identified during the next-day follow-up among SDD cohort. Compared to those who stayed overnight, SDD patients had a lower 30-day readmission rate (p < 0.001), but not 30-day mortality (p = 1.000). Radial access, some procedural-related and comorbidities of patients significantly predicted SDD. Conclusions SDD is safe and feasible when a dedicated protocol has been implemented. The findings support the routine use of this practice.
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Affiliation(s)
| | | | | | - Man Ling Hui
- Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong..
| | - Polly Wai Chi Li
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong. 4/F., William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong.
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17
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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.
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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
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18
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Safety and Feasibility of Same Day Discharge Strategy for Primary Percutaneous Coronary Intervention. Glob Heart 2021; 16:46. [PMID: 34381668 PMCID: PMC8252969 DOI: 10.5334/gh.1035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background: The strategy for early discharge after primary percutaneous coronary intervention (PCI) could have substantial financial benefits, especially in low-middle income countries. However, there is a lack of local evidence on feasibility and safety of the strategy for early discharge. Therefore, the aim of this study was to assess the safety of early discharge after primary PCI in selected low-risk patients in the population of Karachi, Pakistan. Methods: In this study 600 consecutive low-risk patients who were discharged within 48 hours of primary PCI were put under observation for major adverse cardiac events (MACE) after 7 and 30 days of discharge respectively. Patients were further stratified into discharge groups of very early (≤ 24 hours) and early (24 to 48 hours). Results: The sample consisted of 81.8% (491) male patients with mean age of 54.89 ± 11.08 years. Killip class was I in 90% (540) of the patients. The majority of patients (84%) were discharged within 24 hours of the procedure. Loss to follow-up after rate at 7 and 30 days was 4% (24) and 4.3% (26) respectively. Cumulative MACE rate after 7 and 30 days was observed in 3.5% and 4.9%, all-cause mortality in 1.4% and 2.3%, cerebrovascular events in 0.9% and 1.4%, unplanned revascularization in 0.9% and 1.2%, re-infarction in 0.3% and 0.5%, unplanned re-hospitalization in 0.5% and 0.5%, and bleeding events in 0.5% and 0.5% of the patients respectively. Conclusion: It was observed that very early (≤ 24 hours) discharge after primary PCI for low-risk patients is a safe strategy subjected to careful pre-discharge risk assessment with minimal rate of MACE after 7-days as well as 30-days.
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19
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Gaba P, Serruys PW, Karmpaliotis D, Lembo NJ, Banning AP, Zhang Z, Morice MC, Kandzari DE, Gershlick AH, Ben-Yehuda O, Sabik JF, Kappetein AP, Stone GW. Outpatient Versus Inpatient Percutaneous Coronary Intervention in Patients With Left Main Disease (from the EXCEL Trial). Am J Cardiol 2021; 143:21-28. [PMID: 33359193 DOI: 10.1016/j.amjcard.2020.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/30/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
Prior studies in patients with noncomplex coronary artery disease have demonstrated the safety of percutaneous coronary intervention (PCI) in the outpatient setting. We sought to examine the outcomes of outpatient PCI in patients with unprotected left main coronary artery disease (LMCAD). In the EXCEL trial, 1905 patients with LMCAD and site-assessed low or intermediate SYNTAX scores were randomized to PCI with everolimus-eluting stents versus coronary artery bypass grafting. The primary end point was major adverse cardiovascular events (MACE; the composite of death, stroke, or myocardial infarction). In this sub-analysis, outcomes at 30 days and 5 years were analyzed according to whether PCI was performed in the outpatient versus inpatient setting. Among 948 patients with LMCAD assigned to PCI, 935 patients underwent PCI as their first procedure, including 100 (10.7%) performed in the outpatient setting. Patients who underwent outpatient compared with inpatient PCI were less likely to have experienced recent myocardial infarction. Distal left main bifurcation disease involvement and SYNTAX scores were similar between the groups. Comparing outpatient to inpatient PCI, there were no significant differences in MACE at 30 days (4.0% vs 5.0% respectively, adjusted OR 0.52 95% CI 0.12 to 2.22; p = 0.38) or 5 years (20.6% vs 22.1% respectively, adjusted OR 0.72, 95% CI 0.40 to 1.29; p = 0.27). Similar results were observed in patients with distal left main bifurcation lesions. In conclusion, in the EXCEL trial, outpatient PCI of patients with LMCAD was not associated with an excess early or late hazard of MACE. These data suggest that outpatient PCI may be safely performed in select patients with LMCAD.
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Sahashi Y, Kawamura I, Aikawa T, Takagi H, Briasoulis A, Kuno T. Safety and feasibility of same-day discharge in patients receiving pulmonary vein isolation-systematic review and a meta-analysis. J Interv Card Electrophysiol 2021; 63:251-258. [PMID: 33630213 DOI: 10.1007/s10840-021-00967-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this systematic review and meta-analysis was to evaluate the feasibility and safety of a same-day discharge protocol following pulmonary vein isolation (PVI). METHODS PubMed and Embase were systematically investigated from the inception to 20 July 2020. Studies on safety and feasibility of PVI for atrial fibrillation (AF) were included. Study-specific estimates were combined using one-group meta-analysis with a random-effects model. RESULTS Seven observational studies investigating the safety and feasibility of same-day discharge protocols were identified. Of a total of 3656 patients who have undergone PVI for AF, the overall complication rate was 0.80% (95% confidence interval [CI], 0.20-1.40%). The readmission within 30-day following same-day discharge protocol occurred at a pooled rate of 3.6% (95% CI, 0.0-8.4%). Frequent complications following the procedure were complications related to vascular access (0.38%; 95% CI, 0.18-0.58%), and phrenic nerve injury (0.19%; 95% CI, 0.05-0.33%). The reported complications in SDD group were mainly based on results among patients without perioperative complications. CONCLUSIONS The introduction of same-day discharge strategies might be safe and feasible in selected patients given the reported complication and re-admission rates in the current practice. Further prospective studies are needed to confirm these findings.
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Affiliation(s)
- Yuki Sahashi
- Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan.,Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Japan
| | - Iwanari Kawamura
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tadao Aikawa
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Alexandros Briasoulis
- Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Toshiki Kuno
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, First Avenue, 16th Street, New York, NY, 10003, USA.
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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]
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22
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Caputo RP, Levine RL. I'll Take My PCI to Go. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1374-1376. [PMID: 32950405 DOI: 10.1016/j.carrev.2020.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 08/11/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Ronald P Caputo
- Levine Heart and Wellness, 680 2nd Ave N, Naples, FL 34102, United States of America.
| | - Ronald L Levine
- Levine Heart and Wellness, 680 2nd Ave N, Naples, FL 34102, United States of America
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Mols RE, Hald M, Vistisen HS, Lomborg K, Maeng M. Nurse-led Motivational Telephone Follow-up After Same-day Percutaneous Coronary Intervention Reduces Readmission and Contacts to General Practice. J Cardiovasc Nurs 2020; 34:222-230. [PMID: 30789491 DOI: 10.1097/jcn.0000000000000566] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Same-day discharge of patients undergoing percutaneous coronary intervention (PCI) may challenge preparation of patients for discharge. OBJECTIVE The objective of this study was to investigate whether nurse-led telephone follow-up influenced patients' self-management post-PCI. METHODS We performed a randomized study with an allocation rate of 1:1. A standardized nurse-led motivational telephone consultation was conducted between 2 and 5 days after PCI to support adherence to medical therapy, follow-up activities, emotional well-being, and healthy lifestyle. The control group received usual care and discharge procedures. Primary outcome was adherence to use of P2Y12 inhibitor (clopidogrel or ticagrelor) therapy at 30 days of follow-up. RESULTS We consecutively included 294 elective patients (83%) undergoing PCI and with planned same-day discharge. Adherence to P2Y12 inhibitors was not influenced by the intervention (intervention vs control, 95% vs 93%, respectively; P = .627). However, the proportion of patients readmitted (8% vs 16%, P = .048), as well as self-initiated contacts to general practitioners (29% vs 42%, P = .020), was lower in the intervention group compared with the control group. Patients in the intervention group were more likely to know how to manage symptoms of angina pectoris (90% vs 80%, P = .015), and a higher proportion of patients in the intervention group commenced healthy physical activities (53% vs 41%, P = .043). CONCLUSION Nurse-led motivational telephone follow-up did not influence adherence to antiplatelet medical therapy after PCI. However, the intervention positively influenced self-management of angina pectoris and reduced hospital readmissions and self-initiated contacts to general practitioners and hospitals.
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Affiliation(s)
- Rikke Elmose Mols
- Rikke Elmose Mols, PhD, RN Healthcare Researcher, Department of Cardiology, Aarhus University Hospital, Denmark. Marianne Hald, RNProject Nurse, Department of Cardiology, Aarhus University Hospital, Denmark. Heidi Soenderby Vistisen, MCn, RNDevelopment Nurse, Department of Cardiology, Aarhus University Hospital, Denmark. Kirsten Lomborg, PhD, RNProfessor, Department of Clinical Medicine, Aarhus University; and the Research Program in Patient Involvement, Aarhus University Hospital, Denmark. Michael Maeng, PhD, MD Associated Professor and Invasive Cardiologist, Department of Cardiology, Aarhus University Hospital, Denmark
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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
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25
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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.
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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
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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.
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27
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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.
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Al-Hijji MA, Gulati R, Bell M, Kaplan RJ, Feind JL, Lewis BR, Borah BJ, Moriarty JP, Yoon Park J, El Sabbagh A, Kanwar A, Barsness G, Munger T, Asirvatham S, Lerman A, Singh M. Routine Continuous Electrocardiographic Monitoring Following Percutaneous Coronary Interventions. Circ Cardiovasc Interv 2019; 13:e008290. [PMID: 31884835 DOI: 10.1161/circinterventions.119.008290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The clinical utility of routine electrocardiographic monitoring following percutaneous coronary interventions (PCI) is not well studied. METHODS We prospectively evaluated the incidence, cost, and the clinical implications of actionable arrhythmia alarms on telemetry monitoring following PCI. One thousand three hundred fifty-eight PCI procedures (989 [72.8%] for acute coronary syndrome and 369 [27.2%] for stable angina) on patients admitted to nonintensive care unit were identified and divided into 2 groups; group 1, patients with actionable alarms (AA) and group 2, patients with non-AA. AA included (1) ≥3 s electrical pause or asystole; (2) high-grade Mobitz type II atrioventricular block or complete heart block; (3) ventricular fibrillation; (4) ventricular tachycardia (>15 beats); (5) atrial fibrillation with rapid ventricular response; (6) supraventricular tachycardia (>15 beats). Primary outcomes were 30-day all-cause mortality. Cost-savings analysis was performed. RESULTS Incidence of AA was 2.2% (37/1672). Time from end of procedure to AA was 5.5 (0.5, 24.5) hours. Patients with AA were older, presented with acute congestive heart failure or non-ST-segment-elevation myocardial infarction, and had multivessel or left main disease. The 30-day all-cause mortality was significantly higher in patients with AA (6.5% versus 0.3% in non-AA [P<0.001]). Applying the standardized costing approach and tailored monitoring per the American Heart Association guidelines lead to potential cost savings of $622 480.95 for the entire population. CONCLUSIONS AA following PCI were infrequent but were associated with increase in 30-day mortality. Following American Heart Association guidelines for monitoring after PCI can lead to substantial cost saving.
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Affiliation(s)
- Mohammed A Al-Hijji
- Division of Cardiovascular Medicine (M.A.A.-H., R.G., M.B., R.J.K., J.L.F., J.Y.P., A.E.S., A.K., G.B., T.M., S.A., A.L., M.S.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Rajiv Gulati
- Division of Cardiovascular Medicine (M.A.A.-H., R.G., M.B., R.J.K., J.L.F., J.Y.P., A.E.S., A.K., G.B., T.M., S.A., A.L., M.S.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Malcolm Bell
- Division of Cardiovascular Medicine (M.A.A.-H., R.G., M.B., R.J.K., J.L.F., J.Y.P., A.E.S., A.K., G.B., T.M., S.A., A.L., M.S.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Revelee J Kaplan
- Division of Cardiovascular Medicine (M.A.A.-H., R.G., M.B., R.J.K., J.L.F., J.Y.P., A.E.S., A.K., G.B., T.M., S.A., A.L., M.S.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Jeanna L Feind
- Division of Cardiovascular Medicine (M.A.A.-H., R.G., M.B., R.J.K., J.L.F., J.Y.P., A.E.S., A.K., G.B., T.M., S.A., A.L., M.S.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Bradley R Lewis
- Division of Biomedical Statistics and Informatics (B.R.L.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Bijan J Borah
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (B.J.B., J.P.M.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - James P Moriarty
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (B.J.B., J.P.M.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Jae Yoon Park
- Division of Cardiovascular Medicine (M.A.A.-H., R.G., M.B., R.J.K., J.L.F., J.Y.P., A.E.S., A.K., G.B., T.M., S.A., A.L., M.S.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Abdallah El Sabbagh
- Division of Cardiovascular Medicine (M.A.A.-H., R.G., M.B., R.J.K., J.L.F., J.Y.P., A.E.S., A.K., G.B., T.M., S.A., A.L., M.S.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Ardaas Kanwar
- Division of Cardiovascular Medicine (M.A.A.-H., R.G., M.B., R.J.K., J.L.F., J.Y.P., A.E.S., A.K., G.B., T.M., S.A., A.L., M.S.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Gregory Barsness
- Division of Cardiovascular Medicine (M.A.A.-H., R.G., M.B., R.J.K., J.L.F., J.Y.P., A.E.S., A.K., G.B., T.M., S.A., A.L., M.S.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Thomas Munger
- Division of Cardiovascular Medicine (M.A.A.-H., R.G., M.B., R.J.K., J.L.F., J.Y.P., A.E.S., A.K., G.B., T.M., S.A., A.L., M.S.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Samuel Asirvatham
- Division of Cardiovascular Medicine (M.A.A.-H., R.G., M.B., R.J.K., J.L.F., J.Y.P., A.E.S., A.K., G.B., T.M., S.A., A.L., M.S.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Amir Lerman
- Division of Cardiovascular Medicine (M.A.A.-H., R.G., M.B., R.J.K., J.L.F., J.Y.P., A.E.S., A.K., G.B., T.M., S.A., A.L., M.S.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Mandeep Singh
- Division of Cardiovascular Medicine (M.A.A.-H., R.G., M.B., R.J.K., J.L.F., J.Y.P., A.E.S., A.K., G.B., T.M., S.A., A.L., M.S.), Mayo Clinic and Mayo Foundation, Rochester, MN
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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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Amin AP, Pinto D, House JA, Rao SV, Spertus JA, Cohen MG, Pancholy S, Salisbury AC, Mamas MA, Frogge N, Singh J, Lasala J, Masoudi FA, Bradley SM, Wasfy JH, Maddox TM, Kulkarni H. Association of Same-Day Discharge After Elective Percutaneous Coronary Intervention in the United States With Costs and Outcomes. JAMA Cardiol 2019; 3:1041-1049. [PMID: 30267035 DOI: 10.1001/jamacardio.2018.3029] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Same-day discharge (SDD) after elective percutaneous coronary intervention (PCI) is associated with lower costs and preferred by patients. However, to our knowledge, contemporary patterns of SDD after elective PCI with respect to the incidence, hospital variation, trends, costs, and safety outcomes in the United States are unknown. Objective To examine (1) the incidence and trends in SDD; (2) hospital variation in SDD; (3) the association between SDD and readmissions for bleeding, acute kidney injury (AKI), acute myocardial infarction (AMI), or mortality at 30, 90, and 365 days after PCI; and (4) hospital costs of SDD and its drivers. Design, Setting, and Participants This observational cross-sectional cohort study included 672 470 patients enrolled in the nationally representative Premier Healthcare Database who underwent elective PCI from 493 hospitals between January 2006 and December 2015 with 1-year follow-up. Exposures Same-day discharge, defined by identical dates of admission, PCI procedure, and discharge. Main Outcomes and Measures Death, bleeding requiring a blood transfusion, AKI and AMI at 30, 90, or 365 days after PCI, and costs from hospitals' perspective, inflated to 2016. Results Among 672 470 elective PCIs, 221 997 patients (33.0%) were women, 30 711 (4.6%) were Hispanic, 51 961 (7.7%) were African American, and 491 823 (73.1%) were white. The adjusted rate of SDD was 3.5% (95% CI, 3.0%-4.0%), which increased from 0.4% in 2006 to 6.3% in 2015. We observed substantial hospital variation for SDD from 0% to 83% (median incidence rate ratio, 3.82; 95% CI, 3.48-4.23), implying an average (median) 382% likelihood of SDD at one vs another hospital. Among SDD (vs non-SDD) patients, there was no higher risk of death, bleeding, AKI, or AMI at 30, 90, or 365 days. Same-day discharge was associated with a large cost savings of $5128 per procedure (95% CI, $5006-$5248), driven by reduced supply and room and boarding costs. A shift from existing SDD practices to match top-decile SDD hospitals could annually save $129 million in this sample and $577 million if adopted throughout the United States. However, residual confounding may be present, limiting the precision of the cost estimates. Conclusions and Relevance Over 2006 to 2015, SDD after elective PCI was infrequent, with substantial hospital variation. Given the safety and large savings of more than $5000 per PCI associated with SDD, greater and more consistent use of SDD could markedly increase the overall value of PCI care.
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Affiliation(s)
- Amit P Amin
- Cardiovascular Division, Washington University School of Medicine, St Louis, Missouri.,Barnes-Jewish Hospital, St Louis, Missouri.,Center for Value and Innovation, Washington University School of Medicine, St Louis, Missouri
| | - Duane Pinto
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - John A House
- Premier, Inc, Premier Applied Sciences, Charlotte, North Carolina
| | - Sunil V Rao
- The Duke Clinical Research Institute, Durham, North Carolina
| | - John A Spertus
- Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City
| | | | - Samir Pancholy
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Adam C Salisbury
- Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City
| | - Mamas A Mamas
- University of Keele, Keele, Newcastle-under-Lyme, Staffordshire, England
| | - Nathan Frogge
- Cardiovascular Division, Washington University School of Medicine, St Louis, Missouri.,Barnes-Jewish Hospital, St Louis, Missouri
| | - Jasvindar Singh
- Cardiovascular Division, Washington University School of Medicine, St Louis, Missouri.,Barnes-Jewish Hospital, St Louis, Missouri
| | - John Lasala
- Cardiovascular Division, Washington University School of Medicine, St Louis, Missouri.,Barnes-Jewish Hospital, St Louis, Missouri
| | | | | | | | - Thomas M Maddox
- Cardiovascular Division, Washington University School of Medicine, St Louis, Missouri.,Barnes-Jewish Hospital, St Louis, Missouri
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Abstract
See Article Madan et al.
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Affiliation(s)
- Kunal Patel
- University of Texas Southwestern Medical CenterDallasTX
| | - Subhash Banerjee
- University of Texas Southwestern Medical CenterDallasTX
- Veterans Affairs North Texas Health Care SystemDallasTX
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Madan M, Bagai A, Overgaard CB, Fang J, Koh M, Cantor WJ, Garg P, Natarajan MK, So DYF, Ko DT. Same-Day Discharge After Elective Percutaneous Coronary Interventions in Ontario, Canada. J Am Heart Assoc 2019; 8:e012131. [PMID: 31498023 PMCID: PMC6662367 DOI: 10.1161/jaha.119.012131] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/23/2019] [Indexed: 01/24/2023]
Abstract
Background To manage overcrowding and bed shortages in Canadian hospitals, same-day discharge (SDD) after percutaneous coronary intervention (PCI) has emerged as a solution to improve resource utilization. However, limited information exists regarding current trends, hospital variation, and safety of SDD PCI in Canada. Methods and Results We evaluated outpatients undergoing elective PCI in Ontario, Canada, from October 2008 to March 2016. SDD was defined when patients were discharged on the day of PCI, and non-SDD was defined as those patients who had 1 overnight stay. The primary outcome was 30-day all-cause death or hospitalization for acute coronary syndrome. Inverse probability of treatment weighting with propensity score was used to account for differences in baseline and clinical characteristics between SDD and non-SDD groups. Among 35 972 patients who underwent elective PCI at 17 PCI centers in Ontario, 10 801 patients (30%) had SDD PCI and 25 121 patients (70%) had non-SDD PCI. Substantial hospital variation for SDD PCI was observed, ranging from 0% to 87% during the study period. In the propensity-weighted cohort, SDD patients had no significant difference in 30-day rates of death or hospitalization for acute coronary syndrome (1.3% versus 1.6%; hazard ratio: 0.84 [95% CI, 0.65-1.08]; P=0.17) compared with non-SDD patients. SDD and non-SDD patients also had no significant difference in 30-day rates of mortality or coronary revascularization. Conclusions In this large population-based cohort of elective PCI patients, we demonstrated the safety of SDD PCI. Increased adoption of this strategy could lead to improved bed-flow efficiency and substantial savings for the Canadian healthcare system without comprising outcomes.
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Affiliation(s)
- Mina Madan
- Schulich Heart CentreSunnybrook Health Sciences CentreUniversity of TorontoOntarioCanada
| | - Akshay Bagai
- Terrence Donnelly Heart CentreSt. Michael's HospitalUniversity of TorontoOntarioCanada
| | | | | | | | - Warren J. Cantor
- Southlake Regional Medical CentreNewmarketOntarioCanada
- University of TorontoOntarioCanada
| | - Pallav Garg
- Department of Medicine and Department of Biostatistics and EpidemiologyLondon Health Sciences CentreWestern UniversityLondonOntarioCanada
| | | | | | - Dennis T. Ko
- Schulich Heart CentreSunnybrook Health Sciences CentreUniversity of TorontoOntarioCanada
- ICESTorontoOntarioCanada
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Temporal trends in the practice of the transradial approach for percutaneous coronary intervention in a large tertiary center. Coron Artery Dis 2019; 31:40-48. [PMID: 31205054 DOI: 10.1097/mca.0000000000000764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The transradial approach (TRA) has increasingly been adopted for the use of percutaneous coronary interventions (PCI), with reported clinical benefits. Little is known regarding the change in outcomes over time. PATIENTS AND METHODS From our large single-center PCI registry, we have analyzed 15 429 patients in two periods - 2008-2012 (period 1) and 2013-2017 (period 2). We examined the proportions of use of TRA, the influence on in-hospital outcomes, and adjusted long-term effects. RESULTS The rate of TRA rose from 15.9% in period 1 to 69.1% in period 2, including in specific situations such as acute coronary syndrome, chronic total occlusion, bifurcation, calcified lesions, and unprotected left main PCI. In-hospital rates of bleeding were lower for TRA versus transfemoral artery (1.8 vs. 5.1%, overall, P < 0.001), as were rates of additional bleeding events in the following 12 months (1.3 vs. 2.4%, P < 0.001). Following multivariate analysis, use of TRA was associated with a lower 30-day and 4-year rate of the composite outcomes of death, myocardial infarction, target vessel revascularization, or coronary artery bypass surgery [at 4 years, hazard ratio (HR) = 0.86; 95% confidence interval (CI): 0.77-0.96; P = 0.007, during period 1 and HR = 0.62; 95% CI 0.55-0.7; P < 0.0001 during period 2]. Interaction analysis showed a stronger effect at the latter period (HR = 0.69, 95% CI: 0.59-0.81, P < 0.001). CONCLUSION Over a decade of follow-up, TRA has gained acceptance for different PCI scenarios, including complex patients - a course which is associated with consistent short and long-term clinical benefits.
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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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Lu H, Guan W, Zhou Y, Bao H. Early versus late clinical outcomes following same day discharge after elective percutaneous coronary intervention: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e14025. [PMID: 30608455 PMCID: PMC6344175 DOI: 10.1097/md.0000000000014025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Nowadays 57% of the cardiologists based in the United Kingdom and 32% of the cardiologists based in Canada utilize same day discharge (SDD) following elective percutaneous coronary intervention (PCI) as a routine practice. In this analysis, we aimed to systematically assess early versus late clinical outcomes following SDD after elective PCI. METHODS The Medical Literature Analysis and Retrieval System Online, the Cochrane Central, the Resources from the United States National Library of Medicine (www.ClinicalTrials.gov: http://www.clinicaltrials.gov) and EMBASE were carefully searched for relevant English publications which reported early versus late clinical outcomes in patients who were discharged on the same day following revascularization by PCI. Relevant clinical outcomes which were reported in the original studies were considered as the endpoints in this analysis. Odd ratios (OR) and 95% confidence intervals (CI) were used to represent the data, and RevMan 5.3 was used as the statistical software. RESULTS A total number of 21, 687 participants (enrollment time period from the year 1998 to the year 2015) were assigned to this analysis. When early versus late clinical outcomes were compared in patients who were discharged on the same day following elective PCI, major adverse cardiac events (OR: 0.75, 95% CI: 0.31-1.79; P = .51), mortality (OR: 0.26, 95% CI: 0.06-1.06; P = .06), stroke (OR: 1.46, 95% CI: 0.72-2.94; P = .29), arrhythmia (OR: 1.30, 95% CI: 0.64-2.63; P = .47), hematoma (OR: 1.00, 95% CI: 0.60-1.66; P = 1.00) and major bleeding from access site (OR: 1.68, 95% CI: 0.22-12.85; P = .62) were not significantly different. Post-procedural myocardial infarction (OR: 2.01, 95% CI: 0.71-5.70; P = .19) and minor bleeding from access site (OR: 6.61, 95% CI: 0.86-50.66; P = .07) were also similarly manifested. However, re-hospitalization was significantly higher in those patients with late clinical outcomes (OR: 0.18, 95% CI: 0.07-0.44; P = .0002). CONCLUSIONS In those patients who were discharged from the hospital on the same day following elective PCI, no significant difference was observed in the assessed early versus late clinical outcomes. However, late clinical outcomes resulted in a significantly higher rate of re-hospitalization. Larger studies should confirm this hypothesis.
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Affiliation(s)
- Hongtao Lu
- Jingzhou Central Hospital of Cardiology, The Second Clinical Medical College, Yangtze University, Jingzhou
| | - Wenjun Guan
- Jingzhou Central Hospital of Cardiology, The Second Clinical Medical College, Yangtze University, Jingzhou
| | - Yanhua Zhou
- Jingzhou First People's Hospital, the First Clinical Medical College
| | - Hong Bao
- Jiangling County People's Hospital of Cardiology, Jingzhou, Hubei, People's Republic of China
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Mulukutla SR, Babb JD, Baran DA, Boudoulas KD, Feldman DN, Hall SA, Jennings HS, Kapur NK, Rao SV, Reginelli J, Schussler JM, Yang EH, Cigarroa JE. A quality framework for the role of invasive, non‐interventional cardiologists in the present‐day cardiac catheterization laboratory: A multidisciplinary SCAI/HFSA expert consensus statement. Catheter Cardiovasc Interv 2018; 92:1356-1364. [DOI: 10.1002/ccd.27841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 07/29/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Suresh R. Mulukutla
- Department of Medicine, UPMC Heart and Vascular InstituteUniversity of Pittsburgh Pittsburgh Pennsylvania
| | - Joseph D. Babb
- East Carolina Heart InstituteEast Carolina University, Brody School of Medicine Greenville North Carolina
| | - David A. Baran
- Advanced Heart Failure and TransplantSentara Heart Hospital Norfolk Virginia
| | | | - Dmitriy N. Feldman
- Division of Cardiology, Department of MedicineWeill Cornell Medical College New York
| | - Shelley A. Hall
- Baylor Scott & White Heart and Vascular HospitalBaylor University Medical Center Dallas Texas
| | - Henry S. Jennings
- Division of Cardiovascular MedicineVanderbilt University Heart and Vascular Institute Nashville Tennessee
| | - Navin K. Kapur
- Division of Cardiology, Department of MedicineTufts Medical Center Boston Massachusetts
| | - Sunil V. Rao
- The Duke Clinical Research InstituteDuke University Health System Durham North Carolina
| | | | - Jeffrey M. Schussler
- Baylor Scott & White Heart and Vascular HospitalBaylor University Medical Center Dallas Texas
- Division of CardiologyTexas A&M College of Medicine Dallas Texas
| | - Eric H. Yang
- Division of Cardiology, Department of MedicineUniversity of California Los Angeles Los Angeles California
| | - Joaquin E. Cigarroa
- Knight Cardiovascular InstituteOregon Health and Science University Portland Oregon
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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.
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Rodriguez-Araujo G, Cilingiroglu M, Mego D, Hakeem A, Lendel V, Cawich I, Paixao A, Marmagkiolis K, Flaherty P, Rollefson W. Same versus next day discharge after elective transradial PCI: The RAdial SAme Day DischArge after PCI trial. (The RASADDA-PCI trial). CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:7-11. [DOI: 10.1016/j.carrev.2018.05.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/14/2018] [Accepted: 05/29/2018] [Indexed: 10/14/2022]
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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.
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Affiliation(s)
- Luigi Biasco
- Fondazione Cardiocentro Ticino, Lugano, Switzerland
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Agarwal S, Thakkar B, Skelding KA, Blankenship JC. Trends and Outcomes After Same-Day Discharge After Percutaneous Coronary Interventions. Circ Cardiovasc Qual Outcomes 2018; 10:CIRCOUTCOMES.117.003936. [PMID: 28794119 DOI: 10.1161/circoutcomes.117.003936] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 07/06/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite the demonstrated safety of the same-day discharge (SDD) after percutaneous coronary intervention (PCI), uptake of this program has been relatively poor in the United States. We evaluated the temporal trends and variations in the utilization of SDD after PCI during the contemporary era. In addition, we evaluated the predictors of SDD (compared with next-day discharge) and the causes of readmission in these 2 patient cohorts. METHODS AND RESULTS Data were extracted from State Ambulatory Surgical Database and State Inpatient Database from Florida and New York ranging from 2009 to 2013. All adults undergoing PCI in an outpatient setting were included. Data were merged with the directory available from the American Hospital Association to obtain detailed information on hospital-related characteristics. Unplanned readmissions within 7 and 30 days constituted the coprimary outcomes. There was modest increase in the proportion of SDD after PCI from 2.5% in 2009 to 7.4% in 2013 (P-trend <0.001). SDD was more frequently used among male and younger patients with fewer comorbidities. There were considerable differences in the discharge practices among the different hospital types. Larger hospitals, teaching hospitals, and high PCI volume hospitals had higher utilization of SDD compared with their respective counterparts. SDD and next-day discharge cohorts had similar rates of unplanned readmissions, in-hospital mortality, and acute myocardial infarction during follow-up. Furthermore, uninsured patients had significantly lower odds of SDD along with higher incidence of unplanned readmission within 30 days after PCI compared with insured patients. CONCLUSIONS During 2009 to 2013, there has been a modest increase in SDD after PCI. Several demographic and clinical characteristics play critical role in determination of SDD after PCI. There were significant disparities in discharge practices between different sex, racial, and insurance-based strata.
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Affiliation(s)
- Shikhar Agarwal
- From the Department of Cardiology, Section of Interventional Cardiology, Geisinger Medical Center, Danville, PA (S.A., K.A.S., J.C.B.); and Division of Internal Medicine, Rutgers New Jersey Medical School, Newark (B.T.).
| | - Badal Thakkar
- From the Department of Cardiology, Section of Interventional Cardiology, Geisinger Medical Center, Danville, PA (S.A., K.A.S., J.C.B.); and Division of Internal Medicine, Rutgers New Jersey Medical School, Newark (B.T.)
| | - Kimberly A Skelding
- From the Department of Cardiology, Section of Interventional Cardiology, Geisinger Medical Center, Danville, PA (S.A., K.A.S., J.C.B.); and Division of Internal Medicine, Rutgers New Jersey Medical School, Newark (B.T.)
| | - James C Blankenship
- From the Department of Cardiology, Section of Interventional Cardiology, Geisinger Medical Center, Danville, PA (S.A., K.A.S., J.C.B.); and Division of Internal Medicine, Rutgers New Jersey Medical School, Newark (B.T.)
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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.
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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.
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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
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Abstract
Introduction: Laparoscopic donor nephrectomy has provided advantages of decreased postoperative pain and length of stay when compared to the open approach. We provide our results of same-day discharge for laparoscopic donor nephrectomy. Case Presentation: We examined the safety and efficacy of same-day discharge for laparoscopic donor nephrectomy in a retrospective cohort analysis. This institutional review board–approved study began in July 2015, when all consecutive patients who underwent laparoscopic donor nephrectomy were offered same-day discharge. Experimental and control groups were analyzed for differences in sex, age, body mass index, surgery time, estimated blood loss, procedure, complications, length of stay, and distance lived from hospital. Statistical analyses were completed with Mann-Whitney U or Fisher's exact test, as appropriate. Management and Outcome: Eight patients underwent laparoscopic donor nephrectomy during the study period. Of the 8 donors, 4 were discharged on the same day as surgery. The other 4 were discharged the following day. No significant differences were found between the 2 groups with respect to the aforementioned variables. At a median follow-up of 206 days, no complications have been reported. Discussion: The results of our pilot study revealed that same-day discharge is safe and feasible, could have a significant impact on patient satisfaction and healthcare costs, and warrants further study.
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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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Agarwal S. Impact of Travel Time on Same-Day Discharge after Elective Percutaneous Coronary Intervention. Tex Heart Inst J 2017; 44:431. [PMID: 29276448 DOI: 10.14503/thij-17-6467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Shikhar Agarwal
- Department of Cardiology, Geisinger Medical Center, Danville, Pennsylvania
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Sandau KE, Funk M, Auerbach A, Barsness GW, Blum K, Cvach M, Lampert R, May JL, McDaniel GM, Perez MV, Sendelbach S, Sommargren CE, Wang PJ. Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e273-e344. [DOI: 10.1161/cir.0000000000000527] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Lee KY, Wan Ahmad WA, Low EV, Liau SY, Anchah L, Hamzah S, Liew HB, Mohd Ali RB, Ismail O, Ong TK, Said MA, Dahlui M. Comparison of the treatment practice and hospitalization cost of percutaneous coronary intervention between a teaching hospital and a general hospital in Malaysia: A cross sectional study. PLoS One 2017; 12:e0184410. [PMID: 28873473 PMCID: PMC5584952 DOI: 10.1371/journal.pone.0184410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 08/23/2017] [Indexed: 11/25/2022] Open
Abstract
Introduction The increasing disease burden of coronary artery disease (CAD) calls for sustainable cardiac service. Teaching hospitals and general hospitals in Malaysia are main providers of percutaneous coronary intervention (PCI), a common treatment for CAD. Few studies have analyzed the contemporary data on local cardiac facilities. Service expansion and budget allocation require cost evidence from various providers. We aim to compare the patient characteristics, procedural outcomes, and cost profile between a teaching hospital (TH) and a general hospital (GH). Methods This cross-sectional study was conducted from the healthcare providers’ perspective from January 1st to June 30th 2014. TH is a university teaching hospital in the capital city, while GH is a state-level general hospital. Both are government-funded cardiac referral centers. Clinical data was extracted from a national cardiac registry. Cost data was collected using mixed method of top-down and bottom-up approaches. Total hospitalization cost per PCI patient was summed up from the costs of ward admission and cardiac catheterization laboratory utilization. Clinical characteristics were compared with chi-square and independent t-test, while hospitalization length and cost were analyzed using Mann-Whitney test. Results The mean hospitalization cost was RM 12,117 (USD 3,366) at GH and RM 16,289 (USD 4,525) at TH. The higher cost at TH can be attributed to worse patients’ comorbidities and cardiac status. In contrast, GH recorded a lower mean length of stay as more patients had same-day discharge, resulting in 29% reduction in mean cost of admission compared to TH. For both hospitals, PCI consumables accounted for the biggest proportion of total cost. Conclusions The high PCI consumables cost highlighted the importance of cost-effective purchasing mechanism. Findings on the heterogeneity of the patients, treatment practice and hospitalization cost between TH and GH are vital for formulation of cost-saving strategies to ensure sustainable and equitable cardiac service in Malaysia.
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Affiliation(s)
- Kun Yun Lee
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- * E-mail:
| | - Wan Azman Wan Ahmad
- Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ee Vien Low
- Pharmaceutical Services Division, Ministry of Health, Selangor, Malaysia
| | - Siow Yen Liau
- Department of Pharmacy, Queen Elizabeth 2 Hospital, Sabah, Malaysia
- Clinical Research Centre, Queen Elizabeth 2 Hospital, Sabah, Malaysia
| | - Lawrence Anchah
- Department of Pharmacy, Sarawak General Hospital Heart Centre, Sarawak, Malaysia
| | - Syuhada Hamzah
- Administrative Office, Penang General Hospital, Penang, Malaysia
| | - Houng-Bang Liew
- Clinical Research Centre, Queen Elizabeth 2 Hospital, Sabah, Malaysia
- Division of Cardiology, Queen Elizabeth 2 Hospital, Sabah, Malaysia
| | - Rosli B. Mohd Ali
- Department of Cardiology, National Heart Institute, Kuala Lumpur, Malaysia
| | - Omar Ismail
- Division of Cardiology, Penang General Hospital, Penang, Malaysia
| | - Tiong Kiam Ong
- Department of Cardiology, Sarawak General Hospital Heart Centre, Sarawak, Malaysia
| | - Mas Ayu Said
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Maznah Dahlui
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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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.
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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]
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