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Broughton N, Comer K, Casey-Gillman O, Moore L, Antoniou S, Patel R, Fhadil S, Wright P, Ozkor M, Guttmann O, Baumbach A, Wragg A, Jain AJ, Choudry F, Mathur A, Rathod KS, Jones DA. An exploration of the early discharge approach for low-risk STEMI patients following primary percutaneous coronary intervention. Am J Cardiovasc Dis 2023; 13:32-42. [PMID: 37213314 PMCID: PMC10193248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/17/2023] [Indexed: 05/23/2023]
Abstract
Recently, there has been growing interest in the early discharge strategy for low-risk patients who have undergone primary percutaneous coronary intervention (PCI) to treat ST-segment elevation myocardial infarction (STEMI). So far findings have suggested there are multiple advantages of shorter hospital stays, including that it could be a safe way to be more cost- and resource-efficient, reduce cases of hospital-acquired infection and boost patient satisfaction. However, there are remaining concerns surrounding safety, patient education, adequate follow-up and the generalisability of the findings from current studies which are mostly small-scale. By assessing the current research, we describe the advantages, disadvantages and challenges of early hospital discharge for STEMI and discuss the factors that determine if a patient can be considered low risk. If it is feasible to safely employ a strategy like this, the implications for healthcare systems worldwide could be extremely beneficial, particularly in lower-income economies and when we consider the detrimental impacts of the recent COVID-19 pandemic on healthcare systems.
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Affiliation(s)
- Nicole Broughton
- Centre for Cardiovascular Medicine and Devices, Willian Harvey Research Institute, Queen Mary University of LondonLondon EC1A 7BE, UK
| | - Katrina Comer
- Department of Cardiology, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Oliver Casey-Gillman
- Department of Cardiology, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Lizze Moore
- Department of Cardiology, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Sotiris Antoniou
- Department of Pharmacy, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Riyaz Patel
- Department of Cardiology, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Sadeer Fhadil
- Department of Pharmacy, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Paul Wright
- Department of Pharmacy, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Muhiddin Ozkor
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
- Department of Cardiology, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Oliver Guttmann
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
- Department of Cardiology, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, Willian Harvey Research Institute, Queen Mary University of LondonLondon EC1A 7BE, UK
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
- Department of Cardiology, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Andrew Wragg
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
- Department of Cardiology, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Ajay J Jain
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
- Department of Cardiology, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Fizzah Choudry
- Centre for Cardiovascular Medicine and Devices, Willian Harvey Research Institute, Queen Mary University of LondonLondon EC1A 7BE, UK
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
- Department of Cardiology, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Anthony Mathur
- Centre for Cardiovascular Medicine and Devices, Willian Harvey Research Institute, Queen Mary University of LondonLondon EC1A 7BE, UK
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
- Department of Cardiology, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Krishnaraj S Rathod
- Centre for Cardiovascular Medicine and Devices, Willian Harvey Research Institute, Queen Mary University of LondonLondon EC1A 7BE, UK
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
- Department of Cardiology, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Daniel A Jones
- Centre for Cardiovascular Medicine and Devices, Willian Harvey Research Institute, Queen Mary University of LondonLondon EC1A 7BE, UK
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
- Department of Cardiology, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
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Ellis IO, Galea M, Broughton N, Locker A, Blamey RW, Elston CW. Pathological prognostic factors in breast cancer. II. Histological type. Relationship with survival in a large study with long-term follow-up. Histopathology 1992; 20:479-89. [PMID: 1607149 DOI: 10.1111/j.1365-2559.1992.tb01032.x] [Citation(s) in RCA: 315] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The histological tumour type determined by current criteria has been investigated in a consecutive series of 1621 women with primary operable breast carcinoma, presenting between 1973 and 1987. All women underwent definitive surgery with node biopsy and none received adjuvant systemic therapy. Special types, tubular, invasive cribriform and mucinous, with a very favourable prognosis can be identified. A common type of tumour recognized by our group and designated tubular mixed carcinoma is shown to be prognostically distinct from carcinomas of no special type; it has a characteristic histological appearance and is the third most common type in this series. Analysis of subtypes of lobular carcinoma confirms differing prognoses. The classical, tubulo-lobular and lobular mixed types are associated with a better prognosis than carcinomas of no special type; this is not so for the solid variant. Tubulo-lobular carcinoma in particular has an extremely good prognosis similar to tumours included in the 'special type' category above. Neither medullary carcinoma nor atypical medullary carcinoma are found to carry a survival advantage over carcinomas of no special type. The results confirm that histological typing of human breast carcinoma can provide useful prognostic information.
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Affiliation(s)
- I O Ellis
- Department of Histopathology, City Hospital, Nottingham, UK
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