Jayachandiran Vinay, Assadpour Elnaz, Babapulle Sofia, Davey Ryan, De Sabe, Durocher Daniel, Huitema Ashlay, Tzemos Nikolaos, Bagur Rodrigo, Blissett Sarah
London Health Sciences Centre, Division of Cardiology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
CJC Open. 2025 Mar 22;7(6):719-724. doi: 10.1016/j.cjco.2025.03.012. eCollection 2025 Jun.
Our institution implemented a clinical pathway to facilitate early hospital discharge (EHD) in < 48 hours post-primary percutaneous coronary intervention for low-risk ST elevation myocardial infarction. This study characterizes the exclusion criteria, barriers, safety profile, and patient satisfaction for EHD.
We prospectively identified all patients with ST-elevation myocardial infarction between January 2023 and March 2024. Patient characteristics, potential EHD barriers and 30-day readmission rates were recorded. A postdischarge telephone survey assessed patient satisfaction. Patients discharged at ≤ 48 hours formed the EHD cohort; those discharged later comprised the non-EHD cohort. Statistical comparisons were performed using the chi-squared and Mann-Whitney tests, with logistic regression assessing EHD barriers.
Among 433 STEMI patients, 65% (n = 282) were ineligible for EHD, primarily due to revascularization needs (29%) or infarct-related complications (47%). Of 151 eligible patients, 72% (n = 109) achieved EHD. Afternoon presentations were associated with higher EHD rates (82% vs 61%, odds ratio = 3.5, 95% confidence interval 1.57-7.83, = 0.002). Rates of 30--day readmission were lower in the EHD cohort (0% vs 7%, = 0.007). Patient satisfaction (96% vs 95%, = 0.841), perceived appropriate length of stay (91% vs 82%, = 0.15), and intention to attend cardiac rehabilitation (63% vs 67%, = 0.73) were comparable between cohorts.
Revascularization considerations and infarct-related complications were the most common reason for exclusion. Morning or overnight admissions were potential barriers to EHD, suggesting a role for optimized discharge planning. No adverse impacts on safety or patient satisfaction occurred.
我们的机构实施了一项临床路径，以促进低风险ST段抬高型心肌梗死患者在初次经皮冠状动脉介入治疗后48小时内提前出院（EHD）。本研究对EHD的排除标准、障碍、安全性和患者满意度进行了描述。
我们前瞻性地确定了2023年1月至2024年3月期间所有ST段抬高型心肌梗死患者。记录患者特征、潜在的EHD障碍和30天再入院率。出院后电话调查评估患者满意度。在≤48小时出院的患者组成EHD队列；出院较晚的患者组成非EHD队列。使用卡方检验和曼-惠特尼检验进行统计比较，逻辑回归评估EHD障碍。
在433例STEMI患者中，65%（n = 282）不符合EHD标准，主要原因是血运重建需求（29%）或梗死相关并发症（47%）。在151例符合条件的患者中，72%（n = 109）实现了EHD。下午就诊与更高的EHD率相关（82%对61%，优势比 = 3.5，95%置信区间1.57 - 7.83，P = 0.002）。EHD队列的30天再入院率较低（0%对7%，P = 0.007）。各队列之间患者满意度（96%对95%，P = 0.841）、认为的适当住院时间（91%对82%，P = 0.15）和参加心脏康复的意愿（63%对67%，P = 0.73）相当。
血运重建考虑因素和梗死相关并发症是最常见的排除原因。上午或夜间入院是EHD的潜在障碍，提示优化出院计划的作用。对安全性或患者满意度没有不利影响。
