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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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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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König S, Svetlosak M, Grabowski M, Duncker D, Nagy VK, Bogdan S, Vanduynhoven P, Sohaib SMA, Malaczynska-Raipold K, Lane DA, Lenarczyk R, Bollmann A, Hindricks G, Potpara TS, Kosiuk J. Utilization and perception of same-day discharge in electrophysiological procedures and device implantations: an EHRA survey. Europace 2021; 23:149-156. [PMID: 33503658 DOI: 10.1093/europace/euaa301] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/21/2020] [Indexed: 01/18/2023] Open
Abstract
The aim of this European Heart Rhythm Association (EHRA) survey was to assess the utilization of same-day discharge (SDD) in electrophysiology (EP). An online-based questionnaire was shared with the EHRA community between 12 and 30 June 2020 and recorded institutional information, complication assessment, recent experiences, and opinions regarding possible advantages or concerns with SDD. In total, 218 responses from 49 countries provided information on current SDD management. Overall, SDD was implemented in 77.5%, whereas this proportion was significantly higher in tertiary and high-volume centres (83.8% and 85.3%, both P < 0.01). The concept of SDD was most commonly used following implantations of cardiac event recorders (97%), diagnostic EP procedures (72.2%), and implantations of pacemakers with one or two intracardiac leads (50%), while the lowest SDD utilization was observed after catheter ablations of left atrial or ventricular arrhythmias. Within SDD-experienced centres, ∼90% respondents stated that this discharge concept is recommendable or highly recommendable and reported that rates of increased rehospitalization and complication rates were low. Most respondents assumed a better utilization of hospital resources (78.2%), better cost effectiveness (77.3%), and an improved patients' comfort but were concerned about possible impairment of detection (72.5%) and management (78.7%) of late complications. In conclusion, >75% of respondents already implement SDD following EP interventions with a large heterogeneity with regard to specific procedures. Further research is needed to confirm or disprove existing and expected benefits and obstacles.
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Affiliation(s)
- Sebastian König
- Department of Electrophysiology, Heart Center Leipzig at University Hospital, Strümpellstraße 39, 04289 Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Martin Svetlosak
- Department for Arrhythmias and Cardiostimulation, National Institute for Cardiovascular Diseases, Bratislava, Slovakia
| | - Marcin Grabowski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - David Duncker
- Department of Cardiology and Angiology, Hannover Medical School, Hannover Heart Rhythm Center, Hannover, Germany
| | - Vivien K Nagy
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Stefan Bogdan
- Clinical Emergency Hospital of Bucharest, Clinical Electrophysiology and Pacing Laboratory, Bucharest, Romania
| | | | | | | | - Deirdre A Lane
- University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Radoslaw Lenarczyk
- Department of Cardiology Congenital Heart Disease and Electrotherapy, Silesian Medical University, Zabrze, Poland
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University Hospital, Strümpellstraße 39, 04289 Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University Hospital, Strümpellstraße 39, 04289 Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Centre of Serbia, Cardiology Clinic, Belgrade, Serbia
| | - Jedrzej Kosiuk
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.,Department of Cardiology, Helios Hospital Köthen, Köthen, Germany
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