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[Prognostic implications of early discharge from the coronary unit in patients with acute myocardial infarction]
J Bermejo García1, J C Muñoz San José, L de la Fuente Galán
1Servicio de Cardiología, Hospital Universitario, Valladolid.
Insights
Selected patients with myocardial infarction can be discharged early from the Coronary Unit with a low risk of death. Early discharge requires careful patient selection to manage a potential 5% readmission rate within the first month.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Increasing healthcare demand necessitates early patient discharge from Coronary Units.
- Early discharge may impact patient prognosis, particularly for those with myocardial infarction.
Purpose of the Study:
- To analyze the characteristics and outcomes (death, readmission) of myocardial infarction patients discharged within 2 days from the Coronary Unit.
- To identify a low-risk patient profile suitable for early Coronary Unit discharge.
Main Methods:
- A cohort of 978 acute myocardial infarction patients was divided into two groups based on Coronary Unit stay (≤2 days vs. >2 days).
- Baseline characteristics, in-hospital course, and 30-day vital status were compared.
- A subgroup of low-risk patients was specifically analyzed for early discharge complications.
Main Results:
- Patients discharged within 2 days (Group A) had a similar 30-day death or readmission rate (13%) compared to those staying longer (Group B, 13%).
- Independent predictors for shorter Coronary Unit stay included Killip class I on admission and an uncomplicated in-hospital course.
- A low-risk subgroup (378 patients) experienced 0% mortality and a 4% readmission rate at 30 days, though early discharge (≤2 days) was associated with higher first-week readmissions within this subgroup.
Conclusions:
- Early discharge from the Coronary Unit is feasible for selected myocardial infarction patients, with a low risk of mortality.
- A readmission rate of approximately 5% should be anticipated for patients discharged early.
- Careful selection based on clinical factors like Killip class and in-hospital course is crucial for safe early discharge.
Introduction And Objectives:
The high demand for health care has obliged Coronary Units to hasten the discharge of patients in less serious condition and this might be an influence on their prognosis. Our objective have been: a) to analyse the characteristics and the evolution (death or readmission) during the first month of patients with myocardial infarction and very early discharge from the Coronary Unit (stay of 2 days or less), and b) to assess the profile of very low risk group patients for complications who could be discharged early from the Coronary Unit.
Patients And Methods:
A study of 978 consecutive patients who had been admitted for acute myocardial, in faration were divided into two groups according to their length of stay in the Coronary Unit (A < or = 2 and B > 2 days). Their baseline characteristics, course of stay and vital status at month, were compared. A subgroup of patients at low risk was studied and complications that might have arisen from their early discharge from the Coronary Unit were assessed.
Results:
Seventy-three patients (7.5%) died within the first two days. Of the remaining 905, the stay was 2 days or less for 336 patients (group A); and longer than 2 days for 569 (group B). Group A had a higher frequency of dyslipemia, Killip class I on admission, uncomplicated myocardial infarction in the Coronary Unit and the use of beta-blockers and had less frequency of diabetes, Q wave myocardial infarction, anterior infarction or the use of fibrinolytics. In the first month after discharge from the Coronary Unit, 10 patients from group A and 18 patients from group B died, the rate of death or readmission into the Coronary Unit within 30 days was similar between both groups (group A = 13% and group B = 13%). A multiple regression showed that Killip class on admission (p < 0.001) and an uncomplicated course (p < 0.001) were independently related with the length of stay in the coronary unit. A subset of 378 low risk patients (Killip I on admission, uncomplicated course in the ICU and age < 71 years) had no mortality at 30 days and their readmission rate in the first month was 4%. In this subgroup, those patients whose stay was equal to or less than two days were more frequently readmitted in the first week. (group A = 9/197 [5%] and group B = 1/181 ([0.5%]; p = 0.034).
Conclusion:
Selected patients with myocardial infarction can be discharged very early from the Coronary Unit with a low risk of death. A readmission rate following discharge of some 5% must be allowed for these patients.