Kaul Padma, Newby L Kristin, Fu Yuling, Mark Daniel B, Califf Robert M, Topol Eric J, Aylward Phil, Granger Christopher B, Van de Werf Frans, Armstrong Paul W
University of Alberta, Edmonton, Alberta, Canada.
Lancet. 2004 Feb 14;363(9408):511-7. doi: 10.1016/S0140-6736(04)15536-0.
Early discharge of low-risk patients with acute myocardial infarction is feasible and can be achieved at no additional risk of adverse events. We aimed to identify the extent to which countries have taken advantage of the opportunity for early discharge.
The study population consisted of 54174 patients enrolled in GUSTO-I, GUSTO-III, and ASSENT-2 studies (enrollment period 1990-98) in the USA, Canada, Australia, New Zealand, Belgium, France, Germany, Spain, and Poland. We identified patients with uncomplicated acute myocardial infarction who were eligible for early discharge on the basis of previously established criteria, and assessed the extent to which these patients were discharged early--defined as discharged alive within 4 days of admission. The economic consequences (defined as potentially unnecessary hospital days consumed per 100 patients enrolled) were also investigated.
Patients in all European countries had significantly longer stays than did those from non-European countries. Over the study period, the number of eligible patients discharged on or before day 4 increased in the USA, Canada, Australia, and New Zealand. Despite this increase, no more than 40% of patients who were eligible for early discharge were actually discharged early. The rate of early discharge of eligible patients was consistently low (<2%) in Belgium, France, Germany, Spain, and Poland. In ASSENT-2, which is the most recent trial in this study, the number of potentially unnecessary hospital days (per 100 patients enrolled) ranged from 65 in New Zealand to 839 in Germany.
Despite more than a decade of research, there is still a lot of variation between countries in international length-of-stay patterns in acute myocardial infarction. The potential for more efficient discharge of low-risk patients exists in all countries investigated, but was especially evident in the European countries included in the study (Belgium, France, Germany, Spain, and Poland).
急性心肌梗死低风险患者早期出院是可行的，且不会增加不良事件的额外风险。我们旨在确定各国利用早期出院机会的程度。
研究人群包括在美国、加拿大、澳大利亚、新西兰、比利时、法国、德国、西班牙和波兰参加GUSTO - I、GUSTO - III和ASSENT - 2研究（入组时间为1990 - 1998年）的54174例患者。我们确定了符合先前制定标准的无并发症急性心肌梗死患者，并评估这些患者早期出院的程度——定义为入院后4天内活着出院。还调查了经济后果（定义为每100名入组患者消耗的潜在不必要住院天数）。
所有欧洲国家的患者住院时间明显长于非欧洲国家的患者。在研究期间，美国、加拿大、澳大利亚和新西兰在第4天或之前出院的符合条件患者数量有所增加。尽管有这种增加，但实际早期出院的符合早期出院条件的患者不超过40%。在比利时、法国、德国、西班牙和波兰，符合条件患者的早期出院率一直很低（<2%）。在本研究中最新的ASSENT - 2试验中，潜在不必要住院天数（每100名入组患者）从新西兰的65天到德国的839天不等。
尽管经过了十多年的研究，但各国在急性心肌梗死国际住院时间模式方面仍存在很大差异。所有被调查国家都存在更有效地让低风险患者出院的潜力，但在纳入研究的欧洲国家（比利时、法国、德国、西班牙和波兰）尤为明显。
