Same Day Discharge Can Be Achieved Safely in the Majority of Elderly Patients Undergoing Elective Percutaneous Coronary Intervention

Ranchord, Anil; Prasad, S.; Seneviratne, Sujith; Anscombe, Russell; Simmonds, Mark; Matsis, P.; Aitken, Andrew; Harding, Scott

doi:10.1016/j.hlc.2008.03.056

Cited by 7 publications

(9 citation statements)

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“…There is an emerging body of literature 7,12,14,28 suggesting that SDD may be performed in more complex and elderly patients undergoing PCI, in whom complex characteristics alone are not sufficient indicators for necessitating overnight admission. Unfortunately, the existing SDD "criteria," 17 which are applicable to a lower-risk population, are potentially too conservative to be applied in an increasingly complex elective PCI population treated in contemporary practice.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Since the outpatient visits increased more rapidly than that of the inpatients, the outpatient-to-inpatient ratio increased annually. Recent studies have shown that same-day discharge after procedures such as PCI and coronary angiography is feasible and safe [28-30]. Moreover, because of factors such as patient satisfaction, medical costs, and waiting lists the prevalence of same-day discharge is increasing.…”

Section: Discussionmentioning

confidence: 99%

Economic burden of acute coronary syndrome in South Korea: a national survey

Kim

Lee

et al. 2013

BMC Cardiovasc Disord

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BackgroundAcute coronary syndrome (ACS) is highly prevalent in Korea and is the third-leading cause of death in Korea; however, the economic cost of ACS on Korean society has not been investigated. This study examined the economic effect of ACS on the Korean population during the period 2004 to 2009.MethodsThe analysis used the cost of illness (COI) framework. Data on direct medical costs, direct non-medical costs, and productivity loss related to ACS morbidity and mortality were included. The Korean National Health Insurance Corporation’s claim database was used to obtain data on annual healthcare utilization and expenditures for the entire South Korean population. By using a data mining technique, we identified healthcare claims with ACS-related disease codes. Costs were estimated by using a macro-costing method.ResultsIn 2009, the prevalence of ACS in Korea was 6.4 persons per 1,000 population members and the associated mortality rate was 20.2 persons per 100,000 population members. The total cost of ACS in 2009 was USD 918.2 million. Of the total, direct medical cost was USD 425.3 million, direct non-medical cost was USD 11.4 million, and cost associated with morbidity and mortality was USD 481.5 million.ConclusionsThe results show that the total cost of ACS to the Korean society is high. Early and effective management of ACS is required to reduce ACS-associated mortality and morbidity. We suggest that further research be undertaken to determine ways to reduce the economic effects of ACS and its treatment.

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“…A more recent study which included 212 patients aged 75 years and older in New Zealand demonstrated that same-day discharge, following a 6 hour observation period, is possible in the majority of elderly patients (84%) [71]. This study did, however, show that elderly patients were more likely to be excluded from consideration for outpatient PCI compared with younger patients (4.5% vs 1.2%, p=0.02).…”

Section: Outpatient Percutaneous Coronary Intervention In the Elderlymentioning

confidence: 64%

“…Only two studies have compared the outcomes of outpatient PCI in elderly and younger patients [70,71].…”

Section: Outpatient Percutaneous Coronary Intervention In the Elderlymentioning

confidence: 99%

Elective Percutaneous Coronary Intervention in the Elderly Patient

2011

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Elderly patients account for an increasing number and proportion of patients attending for management of coronary artery disease. Whilst medical therapy remains the cornerstone of management, percutaneous coronary intervention (PCI) has been shown to improve symptoms of angina and quality of life in elderly patients. PCI is now a routine treatment for both acute and chronic coronary artery disease. In the last decade, a series of technological and therapeutic developments have reduced in-hospital complications following PCI. The transradial approach is associated with fewer vascular complications, reduced bed utilization and reduced time to ambulation. This has facilitated the introduction and expansion of outpatient PCI which has been shown to be as safe and effective in elderly patients. This paper reviews the rationale for outpatient PCI in the elderly and the evidence for its effectiveness and safety. Importance of coronary artery disease in the elderlyIn common with other European countries, the United Kingdom has seen substantial rises in life expectancy at birth and at 65 years which, together with reduced fertility rates, has resulted in an increasingly older population [1,2]. However, there have been much smaller increases in healthy life expectancy and disability-free life expectancy resulting in a decrease in the proportion of life spent in "favourable health states" [3]. The proportion of people reporting that they have a limiting longstanding illness is higher in the older population, with 37% of 65-74 year olds and 48% of those over 75 years reporting that they have such an illness [4].Coronary arterial disease remains the most commonly reported limiting longstanding illness and accounts for more than a quarter of all deaths in both men and women. Mortality and morbidity from coronary artery disease is strongly associated with age. The age-sex standardised mortality rate under 75 years of age is 56 per 100,000 population, compared with 1,437 per 100,000 population among those aged 75 years and over [101]. Amongst people aged 75 years and over, more than one-third of men and around one-quarter of women are currently living with coronary artery disease [102]. As a consequence of the aging population, it is estimated that this will rise by 42% over the next decade [5]. This will result in the elderly accounting for an increasing proportion of patients presenting to health care services for treatment of symptomatic coronary artery disease.

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Same Day Discharge Can Be Achieved Safely in the Majority of Elderly Patients Undergoing Elective Percutaneous Coronary Intervention

Cited by 7 publications

References 0 publications

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

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

Economic burden of acute coronary syndrome in South Korea: a national survey

Elective Percutaneous Coronary Intervention in the Elderly Patient

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