Early Discharge in Low-Risk Patients Hospitalized for Acute Coronary Syndromes: Feasibility, Safety and Reasons for Prolonged Length of Stay

PLoS One. 2016 Aug 23;11(8):e0161493. doi: 10.1371/journal.pone.0161493. eCollection 2016.

Abstract

Introduction: Length of hospital stay (LHS) is an indicator of clinical effectiveness. Early hospital discharge (≤72 hours) is recommended in patients with acute coronary syndromes (ACS) at low risk of complications, but reasons for prolonged LHS poorly reported.

Methods: We collected data of ACS patients hospitalized at the Geneva University Hospitals from 1st July 2013 to 30th June 2015 and used the Zwolle index score to identify patients at low risk (≤ 3 points). We assessed the proportion of eligible patients who were successfully discharged within 72 hours and the reasons for prolonged LHS. Outcomes were defined as adherence to recommended therapies, major adverse events at 30 days and patients' satisfaction using a Likert-scale patient-reported questionnaire.

Results: Among 370 patients with ACS, 255 (68.9%) were at low-risk of complications but only 128 (50.2%)were eligible for early discharge, because of other clinical reasons for prolonged LHS (e.g. staged coronary revascularization, cardiac monitoring) in 127 patients (49.8%). Of the latter, only 45 (35.2%) benefitted from an early discharge. Reasons for delay in discharge in the remaining 83 patients (51.2%) were mainly due to delays in additional investigations, titration of medical therapy, admission or discharge during weekends. In the early discharge group, at 30 days, only one patient (2.2%) had an adverse event (minor bleeding), 97% of patients were satisfied by the medical care.

Conclusion: Early discharge was successfully achieved in one third of eligible ACS patients at low risk of complications and appeared sufficiently safe while being overall appreciated by the patients.

MeSH terms

  • Acute Coronary Syndrome / diagnosis
  • Acute Coronary Syndrome / epidemiology*
  • Acute Coronary Syndrome / therapy
  • Adult
  • Aged
  • Aged, 80 and over
  • Electrocardiography
  • Female
  • Humans
  • Length of Stay*
  • Male
  • Middle Aged
  • Patient Discharge*
  • Patient Satisfaction
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index

Grant support

The work was supported by the Geneva University Hospitals, (P, RD 12-II-2012) Swiss National Science Foundation (SPUM 33CM30-124112 and SPUM 33CM30-140 336, Inflammation and acute coronary syndromes (ACS) – Novel strategies for prevention and clinical management), de Reuter Foundation, Gerbex-Bourget Foundation. B.G.’s research is supported by grants from the Geneva University Hospitals, Swiss Heart Foundation, de Reuter Foundation, Gerbex-Bourget Foundation and Schmidheiny Foundation. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.