Assessing Patient-Reported Outcomes and Preferences for Same-Day Discharge After Percutaneous Coronary Intervention

Kim, Michael; Muntner, Paul; Sharma, Samin K.; Choi, James W.; Stoler, Robert C.; Woodward, Mark; Mann, David; Farkouh, Michael E.

doi:10.1161/circoutcomes.111.000069

Cited by 62 publications

(40 citation statements)

References 31 publications

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“…However, there was considerable disagreement among patients about the desirable length of stay: while a procedure performed in day‐care was among the most preferred, confirming the results of previous studies , equal numbers of patients perceived an overnight stay after the procedure as either most desirable or least desirable. We can only hypothesize that elderly patients might prefer the overnight stay, as this patient group is known to more often have difficulty in coping with postprocedural stress and lack of adequate help at home .…”

Section: Discussionmentioning

confidence: 99%

Patient preference for radial versus femoral vascular access for elective coronary procedures: The PREVAS study

Kok

Weernink

Birgelen

et al. 2017

Cathet Cardio Intervent

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ObjectivesTo explore patient preference for vascular access site in percutaneous coronary procedures, the perceived importance of benefits and risks of transradial access (TRA) and transfemoral access (TFA) were assessed. In addition, direct preference for vascular access and preference for shared decision making (SDM) were evaluated.BackgroundTRA has gained significant ground on TFA during the last decades. Surveys on patient preference have mostly been performed in dedicated TRA trials.MethodsIn the PREVAS study (Clinicaltrials.gov: NCT02625493) a stated preference elicitation method best‐worst scaling (BWS) was used to determine patient preference for six treatment attributes: bleeding, switch of access‐site, postprocedural vessel quality, mobilization and comfort, and over‐night stay. Based on software‐generated treatment scenarios, 142 patients indicated which characteristics they perceived most and least important in treatment choice. Best‐minus‐Worst scores and attribute importance were calculated.ResultsBleeding risk was considered most important (attribute importance 31.3%), followed by length of hospitalization (22.6%), and mobilization(20.2%). Most patients preferred the approach of their current procedure (85.9%); however, 71.1% of patients with experience with both access routes favored TRA (P < 0.001). Most patients (38.0%) appreciated SDM, balanced between patient and cardiologist.ConclusionsPatients appreciate lower bleeding risk and early ambulation, factors favoring TRA. Previous experience with a single access route has a major impact on preference, while experience with both routes generally resulted in preference for TRA. Most patients prefer balanced SDM. © 2017 The Authors Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 99%

Patient preference for radial versus femoral vascular access for elective coronary procedures: The PREVAS study

Kok

Weernink

Birgelen

et al. 2017

Cathet Cardio Intervent

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“…However, what defines “carefully selected” elective PCI patients has been inconsistently applied, if defined at all 2, 3, 4, 5, 6, 7, 8, 9. Some studies have cautiously explored the feasibility of SDD beyond the low‐risk population,7, 10, 11, 12, 13, 14 but they were evaluated in selected patients or required protocols or checklists.…”

mentioning

confidence: 99%

Novel Patient‐Centered Approach to Facilitate Same‐Day Discharge in Patients Undergoing Elective Percutaneous Coronary Intervention

Amin

Crimmins‐Reda

Miller

et al. 2018

JAHA

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BackgroundSame‐day discharge (SDD) after elective percutaneous coronary intervention is safe, less costly, and preferred by patients, but it is usually performed in low‐risk patients, if at all. To increase the appropriate use of SDD in more complex patients, we implemented a “patient‐centered” protocol based on risk of complications at Barnes‐Jewish Hospital.Methods and ResultsOur objectives were as follows: (1) to evaluate time trends in SDD; (2) to compare (a) mortality, bleeding, and acute kidney injury, (b) patient satisfaction, and (c) hospital costs by SDD versus no SDD (NSDD); and (3) to compare SDD eligibility by our patient‐centered approach versus Society for Cardiovascular Angiography and Interventions guidelines. Our patient‐centered approach was based on prospectively identifying personalized bleeding, mortality, and acute kidney injury risks, with a personalized safe contrast limit and mitigating those risks. We analyzed Barnes‐Jewish Hospital's National Cardiovascular Data Registry CathPCI Registry data from July 1, 2009 to September 30, 2015 (N=1752). SDD increased rapidly from 0% to 77% (P<0.001), independent of radial access. Although SDD patients were comparable to NSDD patients, SDD was not associated with adverse outcomes (0% mortality, 0% bleeds, and 0.4% acute kidney injury). Patient satisfaction was high with SDD. Propensity score–adjusted costs were $7331 lower/SDD patient (P<0.001), saving an estimated $1.8 million annually. Only 16 patients (6.95%) met the eligibility for SDD by Society for Cardiovascular Angiography and Interventions guidelines, implying our patient‐centered approach markedly increased SDD eligibility.ConclusionsWith a patient‐centered approach, SDD rapidly increased and was safe in 75% of patients undergoing elective percutaneous coronary intervention, despite patient complexity. Patient satisfaction was high, and hospital costs were lower. Patient‐centered decision making to facilitate SDD is an important opportunity to improve the value of percutaneous coronary intervention.

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“…In this era of increasing focus on rising healthcare expenditure, same‐day discharge is associated with reduced costs and greater efficiency. Furthermore, a shorter length of stay after PCI is preferred by the majority of patients . Despite these apparent benefits, the appropriate length of stay after elective PCI remains poorly defined in clinical guidelines and our survey found that routine same‐day discharge is performed by a minority of responding cardiologists.…”

Section: Discussionmentioning

confidence: 84%

Variation in practice and concordance with guideline criteria for length of stay after elective percutaneous coronary intervention

Din

Snow

Rao

et al. 2017

Cathet Cardio Intervent

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There is considerable variation in practice patterns regarding length of stay after PCI. Whilst most cardiologists practice overnight observation, a significant minority utilize same-day discharge. There is also lack of familiarity with published guidelines. This variation and knowledge gap confirms an urgent need for updated guidelines and a concerted effort to educate cardiologists on appropriate post-PCI length of stay. © 2017 Wiley Periodicals, Inc.

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Assessing Patient-Reported Outcomes and Preferences for Same-Day Discharge After Percutaneous Coronary Intervention

Cited by 62 publications

References 31 publications

Patient preference for radial versus femoral vascular access for elective coronary procedures: The PREVAS study

Patient preference for radial versus femoral vascular access for elective coronary procedures: The PREVAS study

Novel Patient‐Centered Approach to Facilitate Same‐Day Discharge in Patients Undergoing Elective Percutaneous Coronary Intervention

Variation in practice and concordance with guideline criteria for length of stay after elective percutaneous coronary intervention

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