Value-Based ST-Segment-Elevation Myocardial Infarction Care Using Risk-Guided Triage and Early Discharge

Area of Science:

• Cardiology
• Health Economics
• Clinical Triage

Background:

• Prior studies suggest early discharge for low-risk ST-segment-elevation myocardial infarction (STEMI) patients post-primary percutaneous coronary intervention.
• The study addresses the need to decrease healthcare costs associated with STEMI care while maintaining optimal patient outcomes.

Purpose of the Study:

• To implement and evaluate an STEMI risk score for guiding patient triage and discharge.
• To assess the impact of risk-guided care on healthcare value, including costs and patient outcomes.

Main Methods:

• Retrospective application of the Zwolle Risk Score to 967 patients undergoing primary percutaneous coronary intervention (2009-2011).
• Development and electronic medical record integration of a modified Zwolle Risk Calculator for a fast-track protocol.
• Prospective evaluation of the protocol in 549 STEMI patients.

Main Results:

• Low-risk STEMI patients (62% prospectively) had significantly lower complication rates (8.3% vs 38.7%) and in-hospital mortality (0.4% vs 12.5%) compared to high-risk patients.
• The fast-track protocol for low-risk patients resulted in a shorter median length of stay (2 days vs 3 days) and lower overall costs ($6720 vs $11,783).
• On-protocol low-risk patients demonstrated further reductions in length of stay and costs compared to off-protocol patients and those in the retrospective cohort.

Conclusions:

• Risk-guided triage and early discharge for STEMI patients after primary percutaneous coronary intervention enhance healthcare value.
• The implemented protocol successfully reduced costs without negatively impacting patient outcomes or quality of care.
• The modified Zwolle Risk Calculator effectively supports the fast-track protocol for eligible low-risk STEMI patients.