Association of Prolonged Emergency Department Length of Stay with Adverse Events in Patients with Non-ST-Elevation Acute Coronary Syndrome

Abstract

Objective To study the association between prolonged emergency department length of stay (EDLOS) and in-hospital adverse events in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Methods In this retrospective cohort study, the medical records of 738 patients diagnosed with NSTE-ACS and admitted to the emergency department (ED) from 1 January 2013 to 31 December 2019 were reviewed. The patients were categorized into groups with EDLOS < 4 hours and EDLOS ≥ 4 hours, and baseline characteristics, clinical presentation, Killip classification, Global Registry of Acute Coronary Events score, investigations, use of the European Society of Cardiology (ESC) 0/1-hour and 0/3-hour algorithms, and treatments in the ED were compared between the groups. The associations of in-hospital adverse events with EDLOS were examined using univariate logistic regression. Results Four hundred and twenty-three (57.3%) patients had an EDLOS of ≥ 4 hours, and the median (IQR) EDLOS was 4.48 hours (3.03, 6.20 hours). EDLOS ≥ 4 h was associated with a prolonged time to receive P2Y 12 inhibitors and anticoagulants (P < 0.001). However, the two groups showed no significant differences in in-hospital adverse events (congestive heart failure [CHF], shock, stroke or transient ischemic attack [TIA], major bleeding, arrhythmia, recurrent myocardial infarction, death, and one or more adverse events). Nevertheless, a non-significant trend for a higher rate of adverse events (CHF, shock, major bleeding, arrhythmia, recurrent myocardial infarction, death, and one or more adverse events) with longer EDLOS was observed in the subgroup of patients who received diuretic or antiarrhythmic drugs, ventilator or bilevel positive airway pressure support, oxygen support, or inotropic/vasopressor drugs in the ED. Conclusion Prolonged EDLOS showed a significant association with longer times to receive P2Y 12 inhibitors and anticoagulants. However, the EDLOS < 4 hour and EDLOS ≥ 4 hour groups of patients with NSTE-ACS showed no significant differences in the rates of in-hospital adverse events. Patients who receive cardiovascular medications in the ED or are on respiratory support should be hospitalized as soon as practically possible. Proper use of the 0/1-hour algorithm over the 0/3-hour algorithm without unnecessary repeated cardiac troponin tests in the ED could reduce the EDLOS in patients with NSTE-ACS.

Characteristics and Admission Preferences of Pediatric Emergency Patients and Their Waiting Time Prediction Using Electronic Medical Record Data: Retrospective Comparative Analysis

“…Currently, relevant policies and a series of actions are being implemented by different hospitals, yet more progress is clearly needed, as many problems remain to be solved [3,4]. For instance, similar to previous studies, increased visit volume may result in overcrowding in the emergency department (ED) and increased waiting times for minor and sometimes serious problems [5,6]. Defined by the Food and Drug Administration as data related to a patient's health status, real-world data are increasingly being used in clinical decision-making [7].…”

Association of Quantitative ST- Segment Depression with Early Mortality among Naive Patients of Non- ST- Segment Elevation Acute Coronary Syndrome

“…Due to delays in diagnosis brought on by cardiac troponin testing to differentiate between NSTEMI and UA, the majority of patients with NSTE-ACS frequently need lengthy hospitalizations in the emergency room. 2 While, ST-segment elevation myocardial infarction (STEMI) individuals can be Original Article identified without the need for laboratory testing based on clinical symptoms and electrocardiography (ECG) data. 2,3 A stable plaque, vasospasm such as in Prinzmetal angina, a coronary embolism, or coronary arteritis are instances of conditions that might decrease blood flow.…”

“…2 While, ST-segment elevation myocardial infarction (STEMI) individuals can be Original Article identified without the need for laboratory testing based on clinical symptoms and electrocardiography (ECG) data. 2,3 A stable plaque, vasospasm such as in Prinzmetal angina, a coronary embolism, or coronary arteritis are instances of conditions that might decrease blood flow. NSTEMI can also result from non-coronary heart damage such as cardiac contusion, myocarditis, or the presence of cardiotoxic chemicals.…”