eprintid: 10141668
rev_number: 18
eprint_status: archive
userid: 608
dir: disk0/10/14/16/68
datestamp: 2022-01-11 14:12:07
lastmod: 2022-12-22 07:10:29
status_changed: 2022-01-11 14:12:07
type: article
metadata_visibility: show
creators_name: Rathod, KS
creators_name: Comer, K
creators_name: Casey-Gillman, O
creators_name: Moore, L
creators_name: Mills, G
creators_name: Ferguson, G
creators_name: Antoniou, S
creators_name: Patel, R
creators_name: Fhadil, S
creators_name: Damani, T
creators_name: Wright, P
creators_name: Ozkor, M
creators_name: Das, D
creators_name: Guttmann, OP
creators_name: Baumbach, A
creators_name: Archbold, RA
creators_name: Wragg, A
creators_name: Jain, AK
creators_name: Choudry, FA
creators_name: Mathur, A
creators_name: Jones, DA
title: Early Hospital Discharge Following PCI for Patients With STEMI
ispublished: pub
divisions: UCL
divisions: B02
divisions: D14
divisions: GA3
keywords: Early discharge, primary PCI, STEMI
note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
abstract: Background: Regional heart attack services have improved clinical outcomes following ST-segment elevation myocardial infarction (STEMI) by facilitating early reperfusion by primary percutaneous coronary intervention (PCI). Early discharge after primary PCI is welcomed by patients and increases efficiency of health care. Objectives: This study aimed to assess the safety and feasibility of a novel early hospital discharge pathway for low-risk STEMI patients. Methods: Between March 2020 and June 2021, 600 patients who were deemed at low risk for early major adverse cardiovascular events (MACE) were selected for inclusion in the pathway and were successfully discharged in <48 hours. Patients were reviewed by a structured telephone follow-up at 48 hours after discharge by a cardiac rehabilitation nurse and underwent a virtual follow-up at 2, 6, and 8 weeks and at 3 months. Results: The median length of hospital stay was 24.6 hours (interquartile range [IQR]: 22.7-30.0 hours) (prepathway median: 65.9 hours [IQR: 48.1-120.2 hours]). After discharge, all patients were contacted, with none lost to follow-up. During median follow-up of 271 days (IQR: 88-318 days), there were 2 deaths (0.33%), both caused by coronavirus disease 2019 (>30 days after discharge), with 0% cardiovascular mortality and MACE rates of 1.2%. This finding compared favorably with a historical group of 700 patients meeting pathway criteria who remained in the hospital for >48 hours (>48-hour control group) (mortality, 0.7%; MACE, 1.9%) both in unadjusted and propensity-matched analyses. Conclusions: Selected low-risk patients can be discharged safely following successful primary PCI by using a pathway that is supported by a structured, multidisciplinary virtual follow-up schedule.
date: 2021-12-21
date_type: published
official_url: https://doi.org/10.1016/j.jacc.2021.09.1379
oa_status: green
full_text_type: other
language: eng
primo: open
primo_central: open_green
verified: verified_manual
elements_id: 1911238
doi: 10.1016/j.jacc.2021.09.1379
lyricists_name: Patel, Riyaz
lyricists_id: RSPAT27
actors_name: Stacey, Thomas
actors_id: TSSTA20
actors_role: owner
full_text_status: public
publication: Journal of the American College of Cardiology
volume: 78
number: 25
pagerange: 2550-2560
citation:        Rathod, KS;    Comer, K;    Casey-Gillman, O;    Moore, L;    Mills, G;    Ferguson, G;    Antoniou, S;                                                         ... Jones, DA; + view all <#>        Rathod, KS;  Comer, K;  Casey-Gillman, O;  Moore, L;  Mills, G;  Ferguson, G;  Antoniou, S;  Patel, R;  Fhadil, S;  Damani, T;  Wright, P;  Ozkor, M;  Das, D;  Guttmann, OP;  Baumbach, A;  Archbold, RA;  Wragg, A;  Jain, AK;  Choudry, FA;  Mathur, A;  Jones, DA;   - view fewer <#>    (2021)    Early Hospital Discharge Following PCI for Patients With STEMI.                   Journal of the American College of Cardiology , 78  (25)   pp. 2550-2560.    10.1016/j.jacc.2021.09.1379 <https://doi.org/10.1016/j.jacc.2021.09.1379>.       Green open access   
 
document_url: https://discovery.ucl.ac.uk/id/eprint/10141668/3/Patel_24h%20discharge%20manuscript_final.pdf