As COVID-19 cases continue to rise in certain regions due to the spread of the omicron variant, hospitals are hard-pressed finding hospital beds and staff to accommodate the increasing number of patients. Some hospitals have turned to technology-based solutions like telemedicine or telehealth to provide healthcare services to non-urgent cases. But for emergency cases, like in heart attack patients, is there a way to provide quality patient care while preserving scarce hospital resources? Barts Heart Center in London showed a safe way to shorten the hospital stay of low-risk heart attack patients to just 24 hours compared to the usual 3 days.
In their observational study, Rathod et al (1) selected 600 patients between April 2020 and June 2021 who met their criteria for low-risk of major adverse cardiac events (MACE). These patients followed an early discharge guideline to be sent home by 48 hours, with a structured telemedicine follow up and blood pressure machines provided for use at home. They then compared the results with another group of patients who were also deemed low-risk but were hospitalized for >48 hours.
The average hospital stay of the early discharge group was only 24.6 hours versus 65.9 hours in the control group. The MACE occurrence rate was only 1.2% compared with historical data of 1.9% pre-COVID period. The only deaths were due to COVID-19 contracted outside of the hospital. Patient satisfaction in this group also remained high at 85%.
How were they able to achieve such results?
The clinical operators predominantly (94%) use radial access* for percutaneous coronary intervention (PCI). Transradial access is known to decrease the risk of bleeding during the procedure. The team also made effective use of frequent telemedicine follow-up to monitor the patients’health status and reinforce cardiac rehabilitation teachings. With the shortened hospital stay, there was also a decreased risk of hospital-acquired infection – a pertinent issue during a pandemic.
More randomized trials about early discharge protocols are still needed before it becomes standard practice. However, this report showed it is possible to make further improvements in hospital resource use without sacrificing quality patient care.
References:
1. Rathod, K. S.,Comer, K., Casey-Gillman, O., Moore, L., Mills, G., Ferguson, G., Antoniou, S.,Patel, R., Fhadil, S., Damani, T., Wright, P., Ozkor, M., Das, D., Guttmann, O.P., Baumbach, A., Archbold, R. A., Wragg, A., Jain, A. K., Choudry, F. A., . .. Jones, D. A. (2021). Early Hospital Discharge Following PCI for Patients WithSTEMI. Journal of the American College of Cardiology, 78(25),2550–2560. https://doi.org/10.1016/j.jacc.2021.09.1379
Along with traditional guidewire types including straight, angle and J shape, the SSS Guidewire comes in additional shapes like the BK, BK1.5M and AM which are suitable for transradial access* angiography.
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