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Simple Risk Score Can Shorten Hospital Stay for Cardiac Patients
A simple-to-use risk score can identify low-risk patients following a severe heart attack — ST-elevation myocardial infarction (STEMI) — and may provide an opportunity to employ early discharge strategies to reduce the length of hospital stay and to save hospital costs without compromising the safety of the patient, according to a study presented by the Minneapolis Heart Institute Foundation on October 23 at the 2012 Transcatheter Cardiovascular Therapeutics (TCT) conference.
Recently, there has been an emphasis on lowering both the hospital length of stay and hospital readmission in patients with severe heart attack, or STEMI, to decrease costs to the overall healthcare system. STEMI patients in the U.S. have shorter lengths of stay in the hospital but increased rates of hospital readmissions compared with other countries.
The Zwolle Percutaneous Coronary Intervention (PCI) Risk Index has been validated to identify low-risk STEMI patients for early discharge. "This is a simple-to-calculate risk score, which takes into account age, three-vessel disease, Killip Class, anterior infarction, ischemic time, and TIMI flow post," said senior author Timothy D. Henry, MD, an interventional cardiologist. "These risk factors can be easily and quickly assessed by the healthcare professionals within a hospital."
For the study, researchers retrospectively applied the Zwolle PCI risk score to all STEMI patients who presented to a large, regional STEMI system between January 2009 and December 2011.
Among the 967 cases, 44% were classified as high risk and 56% as low risk. High-risk patients were older; had more hypertension, diabetes, and previous coronary artery disease; were more likely to have had previous revascularization; and had lower left ventricular ejection fractions.
The low-risk patients had significantly lower mortality rates than the high-risk patients in the in-hospital setting (0% vs. 11.9%, respectively), at 30 days (0.2% vs. 12.9%), and at 1 year (3.9% vs. 16.4%). Similarly, the low-risk patients had fewer complication rates across the board compared with high-risk patients: any complication (6.5% vs. 17.1%), heart failure (0.3% vs. 2.1%), cardiogenic shock (0.3% vs. 5.1%), or new dialysis (0% vs. 1.7%).
“We found that identifying low-risk patients in an easy, inexpensive manner can lead to safe discharge a full day in advance of the high-risk STEMI patients,” Henry said.
The early discharge of 1 day for these low-risk patients led to a savings of nearly $7,000 in total hospital costs.
“This study's findings have immediately manifested as a change in our clinical practice,” Henry added. “As part of our overall quality-improvement program, we are going to use the Zwolle risk score to identify low-risk patients. These patients will avoid the cardiac critical care unit and will have a plan to be discharged in 48 hours.”
Source: Minneapolis Heart Institute Foundation, October 23, 2012.