TY - JOUR
T1 - International differences in evolution of early discharge after acute myocardial infarction
AU - Kaul, Padma
AU - Newby, L. Kristin
AU - Fu, Yuling
AU - Mark, Daniel B.
AU - Califf, Robert M.
AU - Topol, Eric J.
AU - Aylward, Phil
AU - Granger, Christopher B.
AU - Van De Werf, Frans
AU - Armstrong, Paul W.
N1 - Funding Information:
We thank Wei-Ching Chang for assistance with statistical analyses. The GUSTO-I trial was from Bayer, CIBA-Corning, Genentech, ICI Pharmaceuticals, and Sanofi Pharmaceuticals. The GUSTO-III trial was supported by a grant from Boehringer Mannheim Therapeutics. And the ASSENT-2 trial was supported by Boehringer Ingelheim and Genentech. This analysis had no specific funding source.
PY - 2004/2/14
Y1 - 2004/2/14
N2 - Background: Early discharge of low-risk patients with acute myocardial infarction is feasible and can be achieved at no additional risk of adverse events. We aimed to identify the extent to which countries have taken advantage of the opportunity for early discharge. Methods: The study population consisted of 54 174 patients enrolled in GUSTO-I, GUSTO-III, and ASSENT-2 studies (enrolment period 1990-98) in the USA, Canada, Australia, New Zealand, Belgium, France, Germany, Spain, and Poland. We identified patients with uncomplicated acute myocardial infarction who were eligible for early discharge on the basis of previously established criteria, and assessed the extent to which these patients were discharged early - defined as discharged alive within 4 days of admission. The economic consequences (defined as potentially unnecessary hospital days consumed per 100 patients enrolled) were also investigated. Findings: Patients in all European countries had significantly longer stays than did those from non-European countries. Over the study period, the number of eligible patients discharged on or before day 4 increased in the USA, Canada, Australia, and New Zealand. Despite this increase, no more than 40% of patients who were eligible for early discharge were actually discharged early. The rate of early discharge of eligible patients was consistently low (<2%) in Belgium, France, Germany, Spain, and Poland. In ASSENT-2, which is the most recent trial in this study, the number of potentially unnecessary hospital days (per 100 patients enrolled) ranged from 65 in New Zealand to 839 in Germany. Interpretation: Despite more than a decade of research, there is still a lot of variation between countries in international length-of-stay patterns in acute myocardial infarction. The potential for more efficient discharge of low-risk patients exists in all countries investigated, but was especially evident in the European countries included in the study (Belgium, France, Germany, Spain, and Poland).
AB - Background: Early discharge of low-risk patients with acute myocardial infarction is feasible and can be achieved at no additional risk of adverse events. We aimed to identify the extent to which countries have taken advantage of the opportunity for early discharge. Methods: The study population consisted of 54 174 patients enrolled in GUSTO-I, GUSTO-III, and ASSENT-2 studies (enrolment period 1990-98) in the USA, Canada, Australia, New Zealand, Belgium, France, Germany, Spain, and Poland. We identified patients with uncomplicated acute myocardial infarction who were eligible for early discharge on the basis of previously established criteria, and assessed the extent to which these patients were discharged early - defined as discharged alive within 4 days of admission. The economic consequences (defined as potentially unnecessary hospital days consumed per 100 patients enrolled) were also investigated. Findings: Patients in all European countries had significantly longer stays than did those from non-European countries. Over the study period, the number of eligible patients discharged on or before day 4 increased in the USA, Canada, Australia, and New Zealand. Despite this increase, no more than 40% of patients who were eligible for early discharge were actually discharged early. The rate of early discharge of eligible patients was consistently low (<2%) in Belgium, France, Germany, Spain, and Poland. In ASSENT-2, which is the most recent trial in this study, the number of potentially unnecessary hospital days (per 100 patients enrolled) ranged from 65 in New Zealand to 839 in Germany. Interpretation: Despite more than a decade of research, there is still a lot of variation between countries in international length-of-stay patterns in acute myocardial infarction. The potential for more efficient discharge of low-risk patients exists in all countries investigated, but was especially evident in the European countries included in the study (Belgium, France, Germany, Spain, and Poland).
UR - http://www.scopus.com/inward/record.url?scp=10744230653&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(04)15536-0
DO - 10.1016/S0140-6736(04)15536-0
M3 - Article
C2 - 14975612
AN - SCOPUS:10744230653
SN - 0140-6736
VL - 363
SP - 511
EP - 517
JO - Lancet
JF - Lancet
IS - 9408
ER -