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[Outpatient heart catheterization. An analysis of experience accumulated over 10 months]
A J Chaves1, D G Suarez, M N Cano
1Instituto Dante Pazzanese de Cardiologia, São Paulo.
Insights
Outpatient cardiac catheterization is safe for selected patients, improving hospital efficiency and reducing costs. This strategy enables more procedures and better bed utilization for suitable candidates.
Area of Science:
- Cardiology
- Interventional Cardiology
Context:
- Cardiac catheterization is a common diagnostic and interventional procedure.
- Hospital bed utilization and costs are significant concerns in healthcare systems.
Purpose:
- To identify suitable patients for an outpatient cardiac catheterization strategy.
- To evaluate safety and feasibility based on social aspects, risks, and complications within a 24-hour period.
Summary:
- A study of 719 eligible patients undergoing cardiac catheterization excluded those over 75, with acute ischemic syndromes, NYHA class IV, specific catheter types, or general anesthesia.
- Patients were observed for 3 hours post-procedure; those without complications were discharged and evaluated the next day.
- Of 719 patients, 305 were discharged same-day without complications, while 414 were not due to procedure timing, social reasons, physician refusal, left main disease, or complications.
Impact:
- Outpatient cardiac catheterization is a safe and effective strategy for selected patients.
- This approach enhances procedure volume and optimizes hospital bed utilization.
- Implementing outpatient cardiac catheterization can lead to decreased healthcare costs.
Purpose:
To identify patients suitable for outpatient cardiac catheterization strategy, based on social aspects, risks and complications, for a 24 hour period.
Methods:
In a series of 2.126 cases submitted to cardiac catheterization at the Instituto Dante Pazzanese de Cardiologia, between September 1990 and June 1991, were excluded: a) those over 75 years of age; b) the acute ischemic syndromes; c) those in NYHA functional class IV; d) patients who used 7 or 8 French femoral angiographic catheters; e) patients who had undergone general anesthesia, electrophysiological study or endomyocardial biopsy. After the procedure, the patients were observed for a 3 hour period and in the absence of any complication, they were discharged from the hospital, returning the next day for clinical evaluation. If any complication occurred it was registered.
Results:
In a cohort of 719 eligible patients, 68% were male, with a mean age of 55.3 years. Sixty one per cent were in NYHA functional class I and most of them (80.8%) were studied by the brachial approach. Eighty-three per cent of the patients were submitted to coronary angiography, with 52% of them having coronary artery disease. Four hundred and fourteen patients were not discharged on the same day: 217 did not have their procedures finish after 6 p.m., 111 for social-economical reasons, 23 because of their physician's refuse, 8 because of left main coronary disease, 55 because of any kind of complication. All the 305 patients who were discharged on the same day, did not have shown any complication in the next day evaluation.
Conclusion:
Outpatient cardiac catheterization is a safe technique in selected patients, making possible the accomplishment of a greater number of procedures improving bed utilization and decreasing hospital costs.