Berger Alan K, Duval Sue, Jacobs David R, Barber Cheryl, Vazquez Gabriela, Lee Seungmin, Luepker Russell V
Department of Medicine, Section of Cardiovascular Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
Am J Cardiol. 2008 Feb 15;101(4):428-34. doi: 10.1016/j.amjcard.2007.09.090.
Hospital length of stay (LOS) after acute myocardial infarction (AMI) has steadily decreased because of both improved treatments and cost considerations. Early discharge may adversely affect some patients who might benefit from extended monitoring. The Minnesota Heart Survey was a population-based study of patients with AMI in acute-care hospitals in the Minneapolis-St. Paul, Minnesota, metropolitan area. Medical records were abstracted for a random sample of patients hospitalized with AMI in 1985, 1990, 1995, and 2001. Case fatality rates, adjusted for age and gender, were identified using mortality data from the index hospitalization and Minnesota death certificates. A total of 4,940 patients with a validated AMI were identified from the combined 1985 (n = 1,306), 1990 (n = 1,550), 1995 (n = 1,087), and 2001 (n = 515) surveys. Median LOSs were 9, 8, 6, and 4 days, respectively. Patients hospitalized <or=4 days formed an increasing proportion of the population, from 11% (1985) to 58% (2001). In-hospital case fatality rates decreased from 1985 to 2001 (11.6% to 5.4%; p <0.0001 for trend). There was a significant decrease in both 1- (3.3% to 2.4%; p = 0.002 for trend) and 6-month (8.9% to 5.4%, p <0.0001) mortality rates after discharge from 1985 to 2001. In conclusion, the progressive and substantial decrease in hospital LOS after AMI in the past 2 decades was not associated with increased mortality after discharge. These decreases in LOS were associated with increasing use of effective therapies.
由于治疗方法的改进和成本因素的考虑，急性心肌梗死（AMI）后患者的住院时间（LOS）已稳步下降。早期出院可能会对一些可能受益于延长监测的患者产生不利影响。明尼苏达心脏调查是一项针对明尼阿波利斯-圣保罗明尼苏达州大都市地区急症医院中AMI患者的基于人群的研究。对1985年、1990年、1995年和2001年因AMI住院的患者随机样本的病历进行了摘要分析。使用首次住院的死亡率数据和明尼苏达州死亡证明，确定了经年龄和性别调整后的病死率。从1985年（n = 1306）、1990年（n = 1550）、1995年（n = 1087）和2001年（n = 515）的综合调查中，共确定了4940例确诊为AMI的患者。中位住院时间分别为9天、8天、6天和4天。住院时间≤4天的患者在总体人群中所占比例不断增加，从1985年的11%增至2001年的58%。1985年至2001年期间，院内病死率有所下降（从11.6%降至5.4%；趋势p<0.0001）。1985年至2001年期间，出院后1个月（从3.3%降至2.4%；趋势p = 0.002）和6个月（从8.9%降至5.4%，p<0.0001）的死亡率均显著下降。总之，在过去20年中，AMI后住院时间的逐步大幅下降与出院后死亡率增加无关。住院时间的这些下降与有效治疗方法使用的增加有关。
