Is Same-Day Discharge After Angioplasty Safe?

Overnight observation after coronary angioplasty has been the standard of care in the United States. The foundations for this practice go back to the early days of balloon angioplasty, when acute occlusion and access-site complications were frequent.

There are several registries and randomized studies showing the clear safety of same-day discharge after coronary angioplasty. This practice has multiple benefits, such as higher patient satisfaction, a reduction in hospital stay, and a reduction in procedural costs.

Despite the evidence, this strategy has been widely resisted in everyday practice, particularly in the United States, where the rate of same-day discharge between 2004 and 2008 was barely 1.25%. This can be credited to medical custom, concerns about safety, lack of training on transradial access or percutaneous closure devices.

Many of these reasons (that prevent the implementation of same-day discharge) have recently improved. In consequence, this study assesses whether the trend has been reversed or if, on the contrary, we must continue to manage patients the same we did in the early days of balloon angioplasty.

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The study assessed all patients registered in a database from Florida and New York who underwent coronary angioplasty sometime between 2009 and 2013.

The primary endpoints were unplanned readmissions within 7 and 30 days.

There was a modest increase in favor of same-day discharge over time, from 2.5% in 2009 to 7.4% in 2013 (p < 0.001). Same-day discharge was more frequently granted to male and younger patients with fewer comorbidities.

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There were considerable differences among different hospital types. Larger hospitals, university hospitals, and high angioplasty volume hospitals used same-day discharge much more frequently compared with smaller hospitals.

Same-day and next-day discharge patients had similar rates of unplanned readmission, mortality, and acute myocardial infarction.

Conclusion

During 2009 to 2013, there has been a modest increase in the use of same-day discharge for patients who have undergone coronary angioplasty. There were no differences as regards adverse events such as unplanned readmission, infarction, or death among same-day and next-day discharge patients.

Editorial

The successful implementation of a program for same-day discharge after coronary angioplasty requires that we know the exact kind of patient and procedure that would benefit the most from this practice.

Frailty, comorbidities, alarm guidelines, social support, and distance between home and the hospital may be parameters that help the process of choosing adequate patients.

In a similar systematic revision, there were no differences in risk between both patient groups. However, this study presents the exact opposite results.

Original title: Trends and Outcomes After Same-Day Discharge After Percutaneous Coronary Interventions.

Reference: Shikhar Agarwal et al. Circ Cardiovasc Qual Outcomes. 2017;10:e003936.

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