Hospital Length of Stay in Patients with Non-ST-segment Elevation Myocardial Infarction - 23/10/12
Requests for reprints should be addressed to Christopher B. Granger, MD, Duke Clinical Research Institute, 2400 Pratt St, Room 0311 Terrace Level, Durham, NC 27705Abstract |
Purpose |
Substantial heterogeneity in hospital length of stay exists among patients admitted with non-ST-segment elevation myocardial infarction. Furthermore, little is known about the factors that impact length of stay.
Methods |
We examined 39,107 non-ST-segment elevation myocardial infarction patients admitted to 351 Acute Coronary Treatment Intervention Outcomes Network Registry-Get With The Guidelines hospitals from January 1, 2007-March 31, 2009 who underwent cardiac catheterization and survived to discharge. Length of stay was categorized into 4 groups (≤2, 3-4, 5-7, and ≥8 days), where prolonged length of stay was defined as >4 days.
Results |
The overall median (25th, 75th) length of stay was 3 (2, 5) days. Patients with a length of stay of >2 days were older with more comorbidities, but were less likely to receive evidence-based therapies or percutaneous coronary intervention. Among the factors associated with prolonged length of stay >4 days were delay to cardiac catheterization >48 hours, heart failure or shock on admission, female sex, insurance type, and admission to the hospital on a Friday afternoon or evening. Hospital characteristics such as academic versus nonacademic or urban versus rural setting, were not associated with prolonged length of stay.
Conclusion |
Patients with longer length of stay have more comorbidities and in-hospital complications, yet paradoxically, are less often treated with evidence-based medications and are less likely to receive percutaneous coronary intervention. Hospital admission on a Friday afternoon or evening and delays to catheterization appear to significantly impact length of stay. A better understanding of factors associated with length of stay in patients with non-ST-segment elevation myocardial infarction is needed to promote safe and early discharge in an era of increasingly restrictive health care resources.
Le texte complet de cet article est disponible en PDF.Keywords : Hospital discharge, Length of stay, Non-ST-segment-elevation myocardial infarction
Plan
| Funding: The ACTION Registry-GWTG is an initiative of the American College of Cardiology Foundation and the American Heart Association, with partnering support from the Society of Chest Pain Centers, Society of Hospital Medicine, and the American College of Emergency Physicians. The registry is sponsored by Bristol-Myers Squibb/Sanofi Pharmaceuticals. This project received infrastructure support from grant number U18HS010548 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. |
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| Conflict of Interest: Dr Lopes reports research funding from Bristol Myers Squibb (<10K); Dr Newby reports research funding from Amylin, AstraZeneca, Bristol Myers Squibb, diaDexus, Eli Lilly & Co., Genetech, Glaxo Smith Kline, Merck & Co. Murdock, Regado Biosciences (>10K); and consulting from AstraZeneca, Regado Biosciences (<10K); Dr Wang reports research funding from Bristol Myers Squibb, Daiichi Sankyo, Heartscape Technologies, Lilly, Sanofi-Aventis, Schering-Plough Corporation, The Medicines Company (>10K); and personal royalties from Lilly (>10K); Dr Ho reports honoraria from Pfizer-Japan (<10K); and consulting from Wellpoint, Inc. (<10K); Dr Wiviott reports research funding from Eli Lilly, Daiichi Sankyo, Merck/Schering Plough (all >10K); and consulting from BMS/Sanfoi, AstraZeneca, Bayer, Medco (all <10K); Dr Peterson reports research funding from Bristol Myers Squibb, Eli Lilly & Co., Johnson & Johnson, Merck & Co., Sanofi-Aventis, American Heart Association, American College of Cardiology, and the Society of Thoracic Surgeons (>10K); Dr Roe reports research funding from Bristol Myers Squibb, Eli Lilly & Co., Novartis Pharmaceuticals, Schering-Plough Corporation (>10K); and consulting from Eli Lilly & Company, Glaxo Smith Kline, Novartis Pharmaceuticals, Orexigen (<10K); Bristol Myers Squibb, KAI Pharmaceuticals, and Sanofi-Aventis (>10K); Dr Granger reports research funding from Astellas Pharma US, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Glaxo Smith Kline, Medtronic Vascular, Merck & Co. (>10K); and consulting from AstraZeneca, Bristol Myers Squibb, Glaxo Smith Kline, Hoffman-LaRoche, Novartis Pharmaceuticals (<10K), and Boehringer Ingelheim (>10K). Dr Vavalle, Ms Chen, and Dr Shah have no disclosures to report. |
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| Authorship: All authors had access to the data and a role in writing the manuscript. |
Vol 125 - N° 11
P. 1085-1094 - novembre 2012 Retour au numéro
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