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Rajabi Moghadam H, Rabbani P, Mazouchi M, Akbari H, Nabovati E, Rabbani S, Bagheri Toolaroud P. Design and evaluation of an electronic follow-up questionnaire for patients after percutaneous coronary intervention. BMC Med Inform Decis Mak 2025; 25:103. [PMID: 40011893 PMCID: PMC11866665 DOI: 10.1186/s12911-025-02931-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/11/2025] [Indexed: 02/28/2025] Open
Abstract
BACKGROUND Patient-centered, measurable, and transparent care is essential for improving healthcare outcomes, particularly for patients undergoing percutaneous coronary intervention (PCI) procedures. Electronic follow-up questionnaires offer the potential for efficient and accurate data collection, enhancing the monitoring of patient experiences and outcomes. This study aimed to design and evaluate an electronic follow-up questionnaire tailored for post-PCI patients, focusing on real-time symptom monitoring and data collection. METHODS This developmental study was conducted in 2020 in three phases. In the first phase, a follow-up questionnaire was developed through a needs assessment and expert consultations. Each item's content validity ratio (CVR) and content validity index (CVI) were evaluated to ensure content validity. The finalized questionnaire elements were then reviewed and refined by a panel of ten cardiologists using the Delphi technique. In the second phase, an electronic platform was designed to host the follow-up questionnaire. The tool's effectiveness for post-PCI follow-up was evaluated in the third phase. RESULTS Cardiologists confirmed all items in the Delphi technique's first round, validating the follow-up questionnaire's content. A total of 41 patients undergoing PCI were enrolled in the study. The most frequently reported symptoms included issues at the catheter insertion site, chest discomfort, digestive complications, and shortness of breath. Of these patients, 21 (51.2%) utilized the electronic follow-up tool. The primary reasons for non-participation were busy schedules, forgetfulness, and perceived recovery. Among the participants, 16 (76.2%) expressed high or very high satisfaction with the tool. CONCLUSION The findings suggest that this electronic follow-up questionnaire has the potential to effectively collect clinical data, support academic research, and improve the quality of post-PCI care. However, addressing barriers to patient participation and involving patients in the tool's iterative development will be critical for enhancing its adoption and impact.
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Affiliation(s)
- Hassan Rajabi Moghadam
- Department of Cardiology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Parsa Rabbani
- School of Medical Science, Kashan University of Medical Sciences, Kashan, Iran
| | - Majid Mazouchi
- Department of Cardiology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Akbari
- Social Determinants of Health (SDH) Research Center, Department of Biostatistics and Epidemiology, School of Public Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Ehsan Nabovati
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran
- Department of Health Information Management & Technology, Kashan University of Medical Sciences, Kashan, Iran
| | - Soroosh Rabbani
- School of Medical Science, Kashan University of Medical Sciences, Kashan, Iran
| | - Parissa Bagheri Toolaroud
- Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran.
- Medical Education Research Center, Education Development Center, Guilan University of Medical Sciences, Rasht, Iran.
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Liberman F, Botto F, Benzadon MN, Lamelas PM, Spaletra PM, Mascolo PD, Ordoñez S, Padilla LT, Pedernera GO, Belardi J, Cura FA. Impact of a dedicated radial lounge on same-day discharge percutaneous coronary intervention. Catheter Cardiovasc Interv 2024; 104:1189-1195. [PMID: 39413251 DOI: 10.1002/ccd.31208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 08/10/2024] [Accepted: 08/19/2024] [Indexed: 10/18/2024]
Abstract
BACKGROUND The same-day discharge (SDD) program after elective percutaneous coronary intervention (PCI) is a safe strategy that allows for the optimization of hospital resources. However, the lack of adequate infrastructure and a specially targeted care model may limit its implementation. Our center developed an outpatient care model based on an area designed for percutaneous procedures called radial lounge (RL). AIMS Evaluate the efficacy and safety of the RL care model: (1) SDD rate, (2) patient experience, (3) major adverse cardiac events (MACEs) (in-hospital, 30-day, and 1-year mortality and intervention), and (4) vascular access complication. SECONDARY OBJECTIVE Impact of RL SDD rate on total elective SDD-PCI volume. METHODS We conducted a retrospective observational cohort study at a cardiovascular hospital, including consecutive patients undergoing elective PCI between 2015 and 2022 who were admitted to the conventional hospitalization area (CHA) or the RL about the stated objectives. Patient experience was assessed using the Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. RESULTS A total of 5466 elective PCI procedures were included: 2102 in the RL and 3364 in the CHA. The SDD rate was 85.2% in the RL group and 54% in the CHA. After the implementation of RL, a significant increase in the volume of elective SDD-PCI was observed and patient satisfaction improved significantly (p < 0.005) with CHA. Finally, a greater amount of MACEs were not observed in the RL. CONCLUSIONS The PCI program in RL proved to be safe and effective. It showed a higher rate of SDD and a significant improvement in patient experience was observed without affecting safety.
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Affiliation(s)
- Federico Liberman
- Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
| | - Fernando Botto
- Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
| | - Mariano N Benzadon
- Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
| | - Pablo M Lamelas
- Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Pablo M Spaletra
- Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
| | - Pablo D Mascolo
- Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
| | - Santiago Ordoñez
- Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
| | - Lucio T Padilla
- Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
| | | | - Jorge Belardi
- Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
| | - Fernando A Cura
- Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
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Hakim R, Rangé G. [Outpatient PCI in France: data from the France PCI registry]. Ann Cardiol Angeiol (Paris) 2024; 73:101810. [PMID: 39368419 DOI: 10.1016/j.ancard.2024.101810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Accepted: 08/22/2024] [Indexed: 10/07/2024]
Abstract
Percutaneous coronary intervention (PCI) is the preferred method of revascularization for chronic coronary syndromes. Outpatient PCI has demonstrated, in addition to its reliability and safety, the comfort of patients and the reduction of costs that weigh on our healthcare systems. Nevertheless, it remains largely underutilized in France, with significant disparities between centers, particularly between private and public ones. This article provides an overview of outpatient PCI in France based on the France PCI registry and allows us to position ourselves in relation to our European neighbors.
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Affiliation(s)
- Radwane Hakim
- Service de cardiologie, Centre Hospitalier de Chartres, Chartres, France.
| | - Grégoire Rangé
- Service de cardiologie, Centre Hospitalier de Chartres, Chartres, France
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4
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Ettachfini T, Gibault-Genty G, Blicq E, Godeau G, Fofana CH, Lefèvre G, Ajlani B, Livarek B. [Outpatient coronary angiography and percutaneous coronary interventions before and after the COVID-19 pandemic: experience of the Versailles hospital centre]. Ann Cardiol Angeiol (Paris) 2024; 73:101809. [PMID: 39357419 DOI: 10.1016/j.ancard.2024.101809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Accepted: 08/22/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND Same day discharge (SDD) diagnostic coronary angiography and percutaneous coronary interventions (PCIs) are increasingly performed, and indications extend to more complex procedures and more fragile patients. We report the evolution of SDD interventional cardiology activity in our centre since 2016, particularly before and after the COVID-19 pandemic. Secondarily, we analysed the feasibility and safety of SDD PCI. MATERIALS AND METHODS We analysed the number and percentage of SDD coronary angiograms and PCIs (elective or ad hoc), during 4 periods of 11 months each, from September 2016 to July 2024. Periods 1 and 2 took place before COVID-19, periods 3 and 4 after. We also compared the rate of complications and conversion to hospitalisation between periods 1-2 and 4. RESULTS A total of 9587 procedures were analysed, including 1558 SDD procedures. The total number of SDD interventional cardiology procedures increased progressively over the 4 periods, from 146 SDD procedures (7.5%) in 2016-2017 to 620 (27.2%) in 2023-2024. This increase included both diagnostic coronary angiograms (respectively: 10.9%; 12.2%; 33.6% then 28.9%) and PCIs (respectively: 0.9%; 5.6%; 16.1% then 24.4%). In the immediate post-COVID-19 period, a significant increase, uncorrelated with the natural progression, was observed for SDD diagnostic coronary angiography and ad-hoc PCI. There were no deaths or serious complications, the rate of minor complications (1.1%) and conversion to conventional hospitalisation (4.5%) were low. CONCLUSION Provided a careful patient selection and rigorous organisation, SDD coronary angiography and PCI can safely be performed. The increase in the SDD interventional procedures, favoured by organisational (COVID-19) or economic constraints, need to be amplified.
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Affiliation(s)
- Taha Ettachfini
- Service de cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France; Service de cardiologie, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc.
| | - Géraldine Gibault-Genty
- Service de cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France.
| | - Elodie Blicq
- Service de cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France.
| | - Guillaume Godeau
- Service de cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France.
| | - Cheick-Hamala Fofana
- Service de cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France.
| | - Grégoire Lefèvre
- Service de cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France; Service de cardiologie, Centre Hospitalier de Rambouillet, Rambouillet, France.
| | - Badreddine Ajlani
- Service de cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France; Service de cardiologie, Centre Hospitalier de Rambouillet, Rambouillet, France.
| | - Bernard Livarek
- Service de cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France.
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Quillot M, Lasserre R, Moussa K, Pankert M, Venturelli C, Andrieu S. [Outpatient coronary angiography and angioplastie/ why, how and for wich patients?]. Ann Cardiol Angeiol (Paris) 2024; 73:101805. [PMID: 39306969 DOI: 10.1016/j.ancard.2024.101805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 08/14/2024] [Indexed: 10/22/2024]
Abstract
There is great heterogeneity in lengths of stay in interventional cardiology but the number of outpatient procedures is increasing. The expected benefits of an outpatient procedure are numerous and non-inferiority of this strategy has been demonstrated. Proper selection of patients eligible for this treatment is essential to minimize the risks of unplanned hospitalization and early complications. It is based on clinical, medico-social and organizational criteria. Perfect management of the care pathway based on an organizational unit and a geographical unit is essential.
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Affiliation(s)
- Marine Quillot
- Service de cardiologie, Centre Hospitalier Henri Duffaut, Avignon, France.
| | | | - Karim Moussa
- Service de cardiologie, Centre Hospitalier Henri Duffaut, Avignon, France
| | - Mathieu Pankert
- Service de cardiologie, Centre Hospitalier Henri Duffaut, Avignon, France
| | - Candice Venturelli
- Service de cardiologie, Centre Hospitalier Henri Duffaut, Avignon, France
| | - Stéphane Andrieu
- Service de cardiologie, Centre Hospitalier Henri Duffaut, Avignon, France
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Brandt MC, Alber H, Berger R, Binder RK, Mascherbauer J, Niessner A, Schmid M, Wernly B, Frick M. Same-day discharge after percutaneous coronary procedures-Structured review and comprehensive meta-analysis. Wien Klin Wochenschr 2024; 136:44-60. [PMID: 38743083 PMCID: PMC11093862 DOI: 10.1007/s00508-024-02347-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Percutaneous coronary intervention is a well-established revascularization strategy for patients with coronary artery disease. The safety and feasibility of performing these procedures on a same-day discharge basis for selected patients has been studied in a large number of mostly nonrandomized trials. An up to date literature review should focus on trials with radial access, representing the current standard for coronary procedures in Austria and other European countries. METHODS The aim of this consensus statement is to review the most recent evidence for the safety and feasibility of performing same-day discharge procedures in selected patients. A structured literature search was performed using prespecified search criteria, focusing on trials with radial access procedures. RESULTS A total of 44 clinical trials and 4 large meta-analyses were retrieved, spanning 21 years of clinical evidence from 2001 to 2022. The outcome data from a wide range of clinical settings were unanimous in showing no negative effect on early (24 h) or late (30 day) major adverse events after same-day discharge coronary procedures. Based on nine prospective trials a comprehensive meta-analysis was compiled. Using 1‑month major adverse events data the pooled odds ratio of same-day discharge versus overnight stay procedures was 0.66 (95% confidence interval, CI 0.35-01.24; p = 0.19; I2 0%), indicating a noninferiority in carefully selected patients. CONCLUSION Outcome data from same-day discharge coronary intervention trials with radial access confirm the robust safety profile showing no increase in the risk of major adverse events compared to overnight stay.
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Affiliation(s)
- Mathias C Brandt
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Hannes Alber
- Department of Cardiology, Public Hospital Klagenfurt am Woerthersee, Klagenfurt am Woerthersee, Austria
| | - Rudolf Berger
- Department of Internal Medicine, Brothers of Saint John of God Eisenstadt, Eisenstadt, Austria
| | - Ronald K Binder
- Department of Cardiology and Intensive Care, Klinikum Wels, Wels, Austria
| | - Julia Mascherbauer
- Department of Internal Medicine 3/Cardiology, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Alexander Niessner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Martin Schmid
- Department of Cardiology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Bernhard Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - Matthias Frick
- Department of Internal Medicine I and Cardiology, Teaching Hospital Feldkirch, Feldkirch, Austria
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Brandt MC, Alber H, Berger R, Binder RK, Mascherbauer J, Niessner A, Schmid M, Frick M. Same-day discharge after percutaneous coronary procedures-Consensus statement of the working group of interventional cardiology (AGIK) of the Austrian Society of Cardiology. Wien Klin Wochenschr 2024; 136:61-74. [PMID: 38743084 PMCID: PMC11093795 DOI: 10.1007/s00508-024-02348-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Percutaneous coronary intervention is a well-established revascularization strategy for patients with coronary artery disease. Recent technical advances such as radial access, third generation drug-eluting stents and highly effective antiplatelet therapy have substantially improved the safety profile of coronary procedures. Despite several practice guidelines and a clear patient preference of early hospital discharge, the percentage of coronary procedures performed in an outpatient setting in Austria remains low, mostly due to safety concerns. METHODS The aim of this consensus statement is to provide a practical framework for the safe and effective implementation of coronary outpatient clinics in Austria. Based on a structured literature review and an in-depth analysis of available practice guidelines a consensus statement was developed and peer-reviewed within the working group of interventional cardiology (AGIK) of the Austrian Society of Cardiology. RESULTS Based on the available literature same-day discharge coronary procedures show a favorable safety profile with no increase in the risk of major adverse events compared to an overnight stay. This document provides a detailed consensus in various clinical settings. The most important prerequisite for same-day discharge is, however, adequate selection of suitable patients and a structured peri-interventional and postinterventional management plan. CONCLUSION Based on the data analysis this consensus document provides detailed practice guidelines for the safe operation of daycare cathlab programs in Austria.
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Affiliation(s)
- Mathias C Brandt
- Department of Internal Medicine II, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Hannes Alber
- Department of Cardiology, Public Hospital Klagenfurt am Woerthersee, Klagenfurt am Woerthersee, Austria
| | - Rudolf Berger
- Department of Internal Medicine, Brothers of Saint John of God Eisenstadt, Eisenstadt, Austria
| | - Ronald K Binder
- Department of Cardiology and Intensive Care, Klinikum Wels, Wels, Austria
| | - Julia Mascherbauer
- Department of Internal Medicine 3/Cardiology, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Martin Schmid
- Department of Cardiology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Matthias Frick
- Department of Internal Medicine I and Cardiology, Teaching Hospital Feldkirch, Feldkirch, Austria
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Krishnaswamy A, Isogai T, Brilakis ES, Nanjundappa A, Ziada KM, Parikh SA, Rodés-Cabau J, Windecker S, Kapadia SR. Same-Day Discharge After Elective Percutaneous Transcatheter Cardiovascular Interventions. JACC Cardiovasc Interv 2023; 16:1561-1578. [PMID: 37438024 DOI: 10.1016/j.jcin.2023.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/23/2023] [Accepted: 05/08/2023] [Indexed: 07/14/2023]
Abstract
Percutaneous transcatheter interventions have evolved as standard therapies for a variety of cardiovascular diseases, from revascularization for atherosclerotic vascular lesions to the treatment of structural cardiac diseases. Concomitant technological innovations, procedural advancements, and operator experience have contributed to effective therapies with low complication rates, making early hospital discharge safe and common. Same-day discharge presents numerous potential benefits for patients, providers, and health care systems. There are several key elements that are shared across the spectrum of interventional cardiology procedures to create a successful same-day discharge pathway. These include appropriate patient and procedure selection, close postprocedural observation, predischarge assessments specific for each type of procedure, and the existence of a patient support system beyond hospital discharge. This review provides the rationale, available data, and a framework for same-day discharge across the spectrum of coronary, peripheral, and structural cardiovascular interventions.
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Affiliation(s)
- Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Aravinda Nanjundappa
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Khaled M Ziada
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sahil A Parikh
- Division of Cardiology and Center for Interventional Vascular Therapy, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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Hames K, White K, Ockerby C, Williams R, Hutchinson AM. Patient perceptions of care quality and discharge information following same-day cardiac catheterization laboratory procedures: A mixed-methods study. Nurs Open 2023; 10:3263-3273. [PMID: 36622955 PMCID: PMC10077407 DOI: 10.1002/nop2.1578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/21/2022] [Accepted: 12/10/2022] [Indexed: 01/11/2023] Open
Abstract
AIMS To examine patients' perceptions of care quality following a same-day procedure in the cardiac catheterization laboratory and understand the extent to which they were prepared for discharge. DESIGN Single-centre, mixed-methods study. METHODS Postdischarge, online survey of patients who underwent a same-day procedure in the cardiac catheterization laboratory (n = 150) and one-on-one interviews with 13 of these patients. RESULTS Survey responses were positive with mean scores between 4.39-4.83 out of five and 63.3% of respondents (n = 95) extremely likely to recommend the service to others. Interview data analysis identified three themes: the care experience, information and education for safe discharge, and follow-up needs. Participants spoke highly of their interactions with clinicians and were satisfied with their care experience. Mode and content of information delivered varied, with some participants lacking guidance about postdischarge health management and clarity about follow-up plans. PATIENT OR PUBLIC CONTRIBUTION Participants were patients.
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Affiliation(s)
- Kate Hames
- Monash Health, Clayton, Victoria, Australia
| | - Kevin White
- Monash Heart, Monash Health, Clayton, Victoria, Australia
| | - Cherene Ockerby
- Centre for Quality and Patient Safety Research - Monash Health Partnership, Monash Health, Clayton, Victoria, Australia
| | - Ruth Williams
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Victoria, Geelong, Australia
| | - Alison M Hutchinson
- Centre for Quality and Patient Safety Research - Monash Health Partnership, Monash Health, Clayton, Victoria, Australia.,School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Victoria, Geelong, Australia
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Hyasat K, Femia G, Alzuhairi K, Ha A, Kamand J, Hasche E, Rajaratnam R, Lo S, Almafragy H, Liou K, Chiha J, Asrress K. Safety, Feasibility and Economic Analysis of Same Day Discharge Following Elective Percutaneous Coronary Intervention. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2022; 16:11795468221116852. [PMID: 36046181 PMCID: PMC9421009 DOI: 10.1177/11795468221116852] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/04/2022] [Indexed: 11/16/2022]
Abstract
Background Advances in percutaneous coronary intervention (PCI) has made the possibility of facilitating same day discharge (SDD) of patients undergoing intervention. We sought to investigate the feasibility, safety and economic impact of such a service. Methods We retrospectively collected data on all patients undergoing outpatient PCI at our institution over a 12-month period. We included in-hospital and 30-day major adverse cardiac events (MACE), vascular complications, acute kidney injury and any re-hospitalisations. We analysed the cost effectiveness of SDD compared to overnight admission post PCI and staged PCI following diagnostic angiography. Results A total of 147 patients undergoing PCI with 129 patients deemed suitable for SDD (88%). Mean age was 65.7 years. Most patients had type C lesions (60.3%); including 4 chronic total occlusions (CTOs). At 30-day follow-up there were no MACE events (0%). There were 10 (7.8%) re-hospitalisations of which majority (70%) were non cardiac presentations. We also included cost analysis for an elective PCI with SDD, which equated to $2090 per patient (total of $269 610 for cohort). Elective PCI with an overnight admission was $4440 per patient (total of $572 760 for cohort), an additional $2350 per patient (total $303 150). Total cost of an angiogram followed by a staged PCI with an overnight stay was $4700 per patient (total $606 300). Conclusion SDD is safe and feasible in the majority of patients that have elective coronary angiography that require PCI. SDD leads to a significant reduction in total cost and hospital stay of patients undergoing elective PCI.
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Affiliation(s)
- Kais Hyasat
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia.,Department of Cardiology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Giuseppe Femia
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia.,Department of Cardiology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Karam Alzuhairi
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
| | - Andrew Ha
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
| | - Joseph Kamand
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
| | - Edmund Hasche
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
| | - Rohan Rajaratnam
- Department of Cardiology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Sidney Lo
- Department of Cardiology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Hamid Almafragy
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
| | - Kevin Liou
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
| | - Joseph Chiha
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
| | - Kaleab Asrress
- Department of Cardiology, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia.,Department of Cardiology, Liverpool Hospital, Liverpool, NSW, Australia
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11
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Asbeutah AA, Junaid M, Hassan F, Avila Vega J, Efeovbokhan N, Khouzam RN, Ibebuogu UN. Same day discharge after structural heart disease interventions in the era of the coronavirus-19 pandemic and beyond. World J Cardiol 2022; 14:271-281. [PMID: 35702323 PMCID: PMC9157608 DOI: 10.4330/wjc.v14.i5.271] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/14/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
With recent advancements in imaging modalities and techniques and increased recognition of the long-term impact of several structural heart disease interventions, the number of procedures has significantly increased. With the increase in procedures, also comes an increase in cost. In view of this, efficient and cost-effective methods to facilitate and manage structural heart disease interventions are a necessity. Same-day discharge (SDD) after invasive cardiac procedures improves resource utilization and patient satisfaction. SDD in appropriately selected patients has become the standard of care for some invasive cardiac procedures such as percutaneous coronary interventions. This is not the case for the majority of structural heart procedures. With the coronavirus disease 2019 pandemic, safely reducing the duration of time spent within the hospital to prevent unnecessary exposure to pathogens has become a priority. In light of this, it is prudent to assess the feasibility of SDD in several structural heart procedures. In this review we highlight the feasibility of SDD in a carefully selected population, by reviewing and summarizing studies on SDD among patients undergoing left atrial appendage occlusion, patent foramen ovale/atrial septal defect closure, Mitra-clip, and trans-catheter aortic valve replacement procedures.
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Affiliation(s)
- Abdulaziz A Asbeutah
- Internal Medicine, University of Tennessee Health Science Center, Memphis, TN 38013, United States
| | - Muhammad Junaid
- Internal Medicine, Forrest City Medical Center, Forrest City, AR 72335, United States
| | - Fatima Hassan
- Internal Medicine, University of Tennessee Health Science Center, Memphis, TN 38013, United States
| | - Jesus Avila Vega
- Internal Medicine, University of Tennessee Health Science Center, Memphis, TN 38013, United States
| | | | - Rami N Khouzam
- Department of Medicine, The University of Tennessee Health Science Center, Memphis, TN 38104, United States.
| | - Uzoma N Ibebuogu
- Department of Cardiology, University of Tennessee Health Science Center, Memphis, TN 38103, United States
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Regnard O, Regnard S. Management of peripheral vascular interventions in an ambulatory setting: a single center retrospective analysis. Ann Vasc Surg 2022; 85:175-182. [DOI: 10.1016/j.avsg.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 02/08/2022] [Accepted: 02/13/2022] [Indexed: 11/17/2022]
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Economic impact And SafetY of Same-Day Discharge following percutaneous coronary intervention: A tertiary care centre experience from northern India (EASY-SDD). CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40:71-77. [PMID: 34776354 DOI: 10.1016/j.carrev.2021.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The literature about the safety and feasibility of same-day discharge (SDD) following complex percutaneous coronary intervention (PCI) and in acute coronary syndrome (ACS) is scarce. The economic impact of SDD has not been evaluated in this geographical region. We in the present study evaluated the safety, feasibility, and economic impact of SDD following PCI at a tertiary care centre of north India. METHODS It was a single-centre, non-randomized, prospective study, in which all consecutive PCI patients during the study period of 15 months were evaluated for SDD using a "patient-centred" approach. The patients who were discharged on the next calendar day were included in the next day discharge (NDD) group. The baseline demographic data including coronary risk factors, clinical presentation, and management details were noted for all patients. All patients were followed up for 6 weeks. The Indian health system is only partially insured, hence most of the expendable costs are borne by patients. In the present study, we computed the total societal expenditure of each PCI which includes both the health system costs and the expenditure borne by the patients. A standardized tool and bottoms up costing method were used for recording out-of-pocket expenditure (OOPE) by the patients and health care expenditure respectively. RESULTS Out of a total of 675 PCI patients, 617 patients were enrolled in the study, and 132/617 (21.39%) patients were discharged the same day. Sixty-five % of patients (86/132) in the SDD cohort and 70% of patients (337/485) in the NDD cohort presented with ACS. Baseline characteristics in the two cohorts were identical. A higher syntax score, greater number of stents, and longer stented segment predicted the NDD. The mean length of stay after PCI in patients with SDD and NDD was 8.71 ± 2.48 and 21.76 ± 2.42 h, respectively. In the SDD group, there were no readmissions or adverse events after discharge till 6 weeks of follow-up. The total mean cost of PCI (health care system and OOPE) for SDD and NDD was Indian Rupees (INR) 129,322.14 [United States dollar (US$) 1810.51] and INR 165500.71 [US$ 2317.01] respectively. An amount of INR 36178.57 (health system cost: INR 10242.76 and OOPE: INR 25935.71 was saved for each SDD. Besides 100 cardiac unit bed days including 85 intensive cardiac care bed days were saved with 21% SDD in the present cohort. CONCLUSION Post PCI SDD is safe and feasible in selected ACS/chronic stable angina patients using the "patient-centred" approach. Besides, decreasing OOPE for the patients, SDD also helps in the efficient use of scarce health system resources.
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Taxiarchi P, Martin GP, Curzen N, Kinnaird T, Ludman P, Johnson T, Kwok CS, Rashid M, Kontopantelis E, Mamas MA. Rotational atherectomy and same day discharge: Safety and growth from a national perspective. Catheter Cardiovasc Interv 2021; 98:678-688. [PMID: 32845064 DOI: 10.1002/ccd.29228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/02/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES We explore whether same day discharge (SDD) is a feasible and safe practice following rotational atherectomy (ROTA) treatment during elective percutaneous coronary intervention (PCI), and examine which baseline characteristics are independently associated with SDD. BACKGROUND SDD following elective ROTA PCI is not recommended as per the recent SCAI consensus. However, reports show it is practiced and no previous study has evaluated its safety and feasibility. METHODS Our dataset included 4,591 patients undergoing elective ROTA PCI in England & Wales within an 8-years period. Independent associations with SDD were quantified via a multiple logistic regression model and the BCIS 30-day mortality risk model was used to evaluate the safety of SDD. RESULTS The majority of elective ROTA PCI cases remain at the hospital for overnight (ON) observation, although SDD rates increased substantially from 6.7% in 2007 to 35.5% in 2014. The use of glycoprotein IIb/IIIa antagonists, Q wave AMI, left main PCI and valvular heart disease were independently associated with ON, while patients operated underwent transradial PCI were more likely to be SDD (OR = 1.77, 95% CI [1.45-2.15]). Over the study period, observed mortality rates were not significantly higher than those expected from the BCIS risk model. CONCLUSIONS Our findings did not show superiority of the ON strategy over SDD for higher risk cases undergoing elective ROTA PCI, in terms of 30-day mortality. This is the first study to examine the safety of SDD after elective ROTA PCI and more should follow.
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Affiliation(s)
- Paraskevi Taxiarchi
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Center, Manchester, UK
| | - Glen P Martin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Center, Manchester, UK
| | - Nick Curzen
- Coronary Research Group, University Hospital Southampton and Faculty of Medicine, University of Southampton, Southampton, UK
| | - Tim Kinnaird
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | | | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Evangelos Kontopantelis
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, UK
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
- Thomas Jefferson University, Philadelphia, Pennsylvania
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Bhatt DL, Sung JG. Same-Day Discharge After Elective PCI: Are We in for a Home Run? JACC Cardiovasc Interv 2021; 14:1667-1669. [PMID: 34353598 DOI: 10.1016/j.jcin.2021.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/22/2021] [Indexed: 12/28/2022]
Affiliation(s)
- Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts, USA.
| | - Jonathan G Sung
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts, USA
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Bradley SM, Kaltenbach LA, Xiang K, Amin AP, Hess PL, Maddox TM, Poulose A, Brilakis ES, Sorajja P, Ho PM, Rao SV. Trends in Use and Outcomes of Same-Day Discharge Following Elective Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2021; 14:1655-1666. [PMID: 34353597 DOI: 10.1016/j.jcin.2021.05.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/26/2021] [Accepted: 05/25/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aims of this study were to describe trends and hospital variation in same-day discharge following elective percutaneous coronary intervention (PCI) and to evaluate the association between trends in same-day discharge and patient outcomes. BACKGROUND Insights on contemporary use of same-day discharge following elective PCI are limited. METHODS In a sequential cross-sectional analysis of 819,091 patients undergoing elective PCI at 1,716 hospitals in the National Cardiovascular Data Registry CathPCI Registry from July 1, 2009, to December 31, 2017, overall and hospital-level trends in same-day discharge were assessed. Among the 212,369 patients who linked to Centers for Medicare and Medicaid Services data, the association between same-day discharge and 30-day mortality and rehospitalization was assessed. RESULTS A total of 114,461 patients (14.0%) were discharged the same day as PCI. The proportion of patients with same-day discharge increased from 4.5% in the third quarter of 2009 to 28.6% in the fourth quarter of 2017. From 2009 to 2017, the rate of same-day discharge increased from 4.3% to 19.5% for femoral-access PCI and from 9.9% to 39.7% for radial-access PCI. Hospital-level variation in the use of same-day discharge persisted throughout (median odds ratio adjusted for year and radial access: 4.15). Risk-adjusted 30-day mortality did not change over time, while risk-adjusted rehospitalization decreased over time and more quickly for same-day discharge (P for interaction <0.001). CONCLUSIONS In the past decade, a large increase in the use of same-day discharge following elective PCI was not associated with worse 30-day mortality or rehospitalization. Hospital-level variation in same-day discharge may represent an opportunity to reduce costs without compromising patient outcomes.
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Affiliation(s)
- Steven M Bradley
- Minneapolis Heart Institute, Minneapolis, Minnesota, USA; Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
| | | | - Katelyn Xiang
- The Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Amit P Amin
- Healthcare Innovation Lab, BJC HealthCare/Washington University School of Medicine, St. Louis, Missouri, USA
| | - Paul L Hess
- Division of Cardiology, Washington University School of Medicine, Saint Louis, Missouri, USA; VA Eastern Colorado Health Care System, Aurora, Colorado, USA; University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Thomas M Maddox
- Healthcare Innovation Lab, BJC HealthCare/Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anil Poulose
- Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Minneapolis, Minnesota, USA; Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Paul Sorajja
- Minneapolis Heart Institute, Minneapolis, Minnesota, USA; Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - P Michael Ho
- Division of Cardiology, Washington University School of Medicine, Saint Louis, Missouri, USA; VA Eastern Colorado Health Care System, Aurora, Colorado, USA; University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sunil V Rao
- The Duke Clinical Research Institute, Durham, North Carolina, USA
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Zhang N, Wilson B, Enty MA, Ketch P, Ulm MA, ElNaggar AC, Daily L, Tillmanns T. Same-day discharge after robotic surgery for endometrial cancer. J Robot Surg 2021; 16:543-548. [PMID: 34236587 DOI: 10.1007/s11701-021-01253-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/08/2021] [Indexed: 10/20/2022]
Abstract
To assess the safety of same-day discharge (SDD) following robotic-assisted endometrial cancer staging and identify risk factors for postoperative admission in a diverse population. A review of patients who underwent robotic-assisted endometrial cancer staging from April 1, 2017 to April 1, 2019 was performed. Patients were evaluated for SDD if they met the following criteria: tolerating oral intake, voiding spontaneously, ambulating, negative orthostatic vitals, postoperative hemoglobin ≤ 2 g/dL from baseline, pain controlled on oral medications, and desire to be discharged. Risk factors for admission were identified. One hundred eighty-seven patients were identified. SDD criteria were met in 158, of which 132 (83.5%) were discharged same day. Median length of stay was 4.5 h. Reasons for admission despite meeting criteria were late surgery time (n = 15), abnormal vitals (n = 9), and personal concerns (n = 2), with risk factors being age ≥ 68 years (OR 2.72; 95% CI, 1.13-6.59), start time 1400 or later (OR = 11.25; 95% CI, 4.35-29.10), ASA ≥ 4 (OR 23.82; 95% CI, 2.54-223.15), history of CVA/MI (OR 5.61; 95% CI, 1.07-29.52), and operative time ≥ 120 min (OR = 3.83; 95% CI 1.36-10.77). Of the SDD cohort, 2 patients (1.3%) presented to the emergency room within 30 days (postoperative day 5 and 23). SDD following robotic-assisted endometrial cancer staging is safe and feasible. Age ≥ 68 years, surgery start time after 1400, ASA ≥ 4, history of CVA/MI, and operative time ≥ 120 min appear predictive of inpatient admission despite meeting SDD criteria.
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Affiliation(s)
- Naixin Zhang
- Department of Obstetrics and Gynecology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ben Wilson
- Division of Gynecologic Oncology, West Cancer Center and Research Institute, 7945 Wolf River Blvd., Memphis, TN, 38138, USA
| | - Morgan A Enty
- Department of Obstetrics and Gynecology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Peter Ketch
- Department of Obstetrics and Gynecology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Michael A Ulm
- Division of Gynecologic Oncology, West Cancer Center and Research Institute, 7945 Wolf River Blvd., Memphis, TN, 38138, USA
| | - Adam C ElNaggar
- Division of Gynecologic Oncology, West Cancer Center and Research Institute, 7945 Wolf River Blvd., Memphis, TN, 38138, USA
| | - Laura Daily
- Division of Gynecologic Oncology, West Cancer Center and Research Institute, 7945 Wolf River Blvd., Memphis, TN, 38138, USA
| | - Todd Tillmanns
- Division of Gynecologic Oncology, West Cancer Center and Research Institute, 7945 Wolf River Blvd., Memphis, TN, 38138, USA.
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Rao SV, Vidovich MI, Gilchrist IC, Gulati R, Gutierrez JA, Hess CN, Kaul P, Martinez SC, Rymer J. 2021 ACC Expert Consensus Decision Pathway on Same-Day Discharge After Percutaneous Coronary Intervention: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2021; 77:811-825. [PMID: 33423859 DOI: 10.1016/j.jacc.2020.11.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Clinical Outcomes of Ambulatory Endovascular Treatment Using 4-French and 6-French Femoral Access Strategies: The Bio4amb Multicentre Trial. Cardiovasc Intervent Radiol 2020; 44:689-697. [PMID: 33367944 PMCID: PMC8060188 DOI: 10.1007/s00270-020-02738-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 12/02/2020] [Indexed: 12/24/2022]
Abstract
Purpose Ambulatory peripheral vascular interventions have been steadily increasing. In ambulatory procedures, 4F devices might be particularly useful having the potential to reduce access-site complications; however, further evidence on their safety and efficacy is needed. Materials and Methods BIO4AMB is a prospective, non-randomized mulitcentre, non-inferiority trial conducted in 35 centres in Europe and Australia comparing the use of 4F- and 6F-compatible devices. The main exclusion criteria included an American Society of Anaesthesiologists class ≥ 4, coagulation disorders, or social isolation. The primary endpoint was access-site complications within 30 days. Results The 4F group enrolled 390 patients and the 6F group 404 patients. Baseline characteristics were similar between the groups. Vascular closure devices were used in 7.7% (4F group) and 87.6% (6F group) of patients. Patients with vascular closure device use in the 4F group were subsequently excluded from the primary analysis, resulting in 361 patients in the 4F group. Time to haemostasis was longer for the 4F group, but the total procedure time was shorter (13.2 ± 18.8 vs. 6.4 ± 8.9 min, p < 0.0001, and 39.1 ± 25.2 vs. 46.4 ± 27.6 min, p < 0.0001). Discharge on the day of the procedure was possible in 95.0% (4F group) and 94.6% (6F group) of patients. Access-site complications were similar between the groups (2.8% and 3.2%) and included predominantly groin haematomas and pseudoaneurysms. Major adverse events through 30 days occurred in 1.7% and 2.0%, respectively. Conclusions Ambulatory peripheral vascular interventions are feasible and safe. The use of 4F devices resulted in similar outcomes compared to that of 6F devices. Supplementary Information The online version of this article (10.1007/s00270-020-02738-5) contains supplementary material, which is available to authorized users.
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Taxiarchi P, Kontopantelis E, Kinnaird T, Curzen N, Banning A, Ludman P, Shoaib A, Rashid M, Martin GP, Mamas MA. Adoption of same day discharge following elective left main stem percutaneous coronary intervention. Int J Cardiol 2020; 321:38-47. [PMID: 32739446 PMCID: PMC7392050 DOI: 10.1016/j.ijcard.2020.07.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/04/2020] [Accepted: 07/24/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study sought to investigate the safety and feasibility of same day discharge (SDD) practice and compare clinical outcomes to patients admitted for overnight stay (ON) undergoing elective left main stem (LMS) percutaneous coronary intervention (PCI). ON observation is still widely practiced in highly complex PCI as the standard of care, with no previous data comparing clinical outcomes in patients undergoing LMS PCI. METHODS We analysed 6452 patients undergoing elective LMS PCI between 2007 and 2014 in England and Wales. Multiple logistic regressions and the BCIS risk model were used to study association between SDD and 30 day mortality. RESULTS SDD rates almost doubled from 19.9% in 2007 to 39.8% in 2014 for all LMS procedures and increased from 20.7% to 41.4% for unprotected LMS cases during the same study period. There was a significant increase in procedural complexity with higher use of rotational atherectomy, longer stents and multivessel PCI. SDD was not associated with increased 30 day mortality (OR 0.70 95%CI 0.30-1.65) in the overall LMS PCI cohort and the results were similar in unprotected LMS (OR 0.48 95%CI 0.17-1.41) and those requiring ON stay (OR 0.58 95%CI 0.25-1.34). CONCLUSIONS We did not find evidence that SDD is not safe or feasible in highly complex LMS PCI procedures despite increasing procedural complexity with no significant increase in 30 day mortality rates.
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Affiliation(s)
- Paraskevi Taxiarchi
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Nick Curzen
- Coronary Research Group, University Hospital Southampton, Faculty of Medicine, University of Southampton, UK
| | | | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Ahmad Shoaib
- Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, University of Keele and Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, University of Keele and Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Glen P Martin
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Mamas A Mamas
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, University of Keele and Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK.
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Caputo RP, Levine RL. I'll Take My PCI to Go. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1374-1376. [PMID: 32950405 DOI: 10.1016/j.carrev.2020.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 08/11/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Ronald P Caputo
- Levine Heart and Wellness, 680 2nd Ave N, Naples, FL 34102, United States of America.
| | - Ronald L Levine
- Levine Heart and Wellness, 680 2nd Ave N, Naples, FL 34102, United States of America
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Mols RE, Hald M, Vistisen HS, Lomborg K, Maeng M. Nurse-led Motivational Telephone Follow-up After Same-day Percutaneous Coronary Intervention Reduces Readmission and Contacts to General Practice. J Cardiovasc Nurs 2020; 34:222-230. [PMID: 30789491 DOI: 10.1097/jcn.0000000000000566] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Same-day discharge of patients undergoing percutaneous coronary intervention (PCI) may challenge preparation of patients for discharge. OBJECTIVE The objective of this study was to investigate whether nurse-led telephone follow-up influenced patients' self-management post-PCI. METHODS We performed a randomized study with an allocation rate of 1:1. A standardized nurse-led motivational telephone consultation was conducted between 2 and 5 days after PCI to support adherence to medical therapy, follow-up activities, emotional well-being, and healthy lifestyle. The control group received usual care and discharge procedures. Primary outcome was adherence to use of P2Y12 inhibitor (clopidogrel or ticagrelor) therapy at 30 days of follow-up. RESULTS We consecutively included 294 elective patients (83%) undergoing PCI and with planned same-day discharge. Adherence to P2Y12 inhibitors was not influenced by the intervention (intervention vs control, 95% vs 93%, respectively; P = .627). However, the proportion of patients readmitted (8% vs 16%, P = .048), as well as self-initiated contacts to general practitioners (29% vs 42%, P = .020), was lower in the intervention group compared with the control group. Patients in the intervention group were more likely to know how to manage symptoms of angina pectoris (90% vs 80%, P = .015), and a higher proportion of patients in the intervention group commenced healthy physical activities (53% vs 41%, P = .043). CONCLUSION Nurse-led motivational telephone follow-up did not influence adherence to antiplatelet medical therapy after PCI. However, the intervention positively influenced self-management of angina pectoris and reduced hospital readmissions and self-initiated contacts to general practitioners and hospitals.
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Affiliation(s)
- Rikke Elmose Mols
- Rikke Elmose Mols, PhD, RN Healthcare Researcher, Department of Cardiology, Aarhus University Hospital, Denmark. Marianne Hald, RNProject Nurse, Department of Cardiology, Aarhus University Hospital, Denmark. Heidi Soenderby Vistisen, MCn, RNDevelopment Nurse, Department of Cardiology, Aarhus University Hospital, Denmark. Kirsten Lomborg, PhD, RNProfessor, Department of Clinical Medicine, Aarhus University; and the Research Program in Patient Involvement, Aarhus University Hospital, Denmark. Michael Maeng, PhD, MD Associated Professor and Invasive Cardiologist, Department of Cardiology, Aarhus University Hospital, Denmark
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Ramsingh R, Maharaj D, Angelini G, Rampersad RD. Safety and Cost-Savings of Same-Day Discharge Trans-Radial Percutaneous Coronary Intervention in Trinidad and Tobago. Cureus 2020; 12:e9568. [PMID: 32905543 PMCID: PMC7473603 DOI: 10.7759/cureus.9568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: Same-day discharge percutaneous coronary interventions (SDD-PCI) may be quite impactful on healthcare burden for small island developing states (SIDS) such as Trinidad and Tobago. Methods: From June 2012 to November 2014, 11 patients underwent SDD trans-radial PCI and followed up at one-month and three months. Data was retrospectively reviewed from a prospectively entered unit-maintained cardiology database. Baseline patient characteristics, in-hospital expenditure, and complications were assessed. Descriptive statistical analysis was performed in Microsoft Excel. Results: The mean age at SDD-PCI was 50.90±9.96 and nine were male. Nine patients were of East Indian Caribbean ethnicity. Six were diabetic and five were hypertensive. Procedural success was 100% with no major early complication or three-months complications; patient satisfaction was achieved with a potential in-hospital savings up to $1480 USD per patient. Conclusion: This SDD approach for elective trans-radial PCI may be safe and cost-effective in properly selected patients and merits a review of relevant policy issues in Trinidad and Tobago.
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Affiliation(s)
- Richard Ramsingh
- Cardiovascular Disease, Caribbean Heart Care Medcorp, Port-of-Spain, TTO
| | - Dale Maharaj
- Vascular Surgery, Caribbean Vascular & Vein Clinic, Port-of-Spain, TTO
| | - Gianni Angelini
- Cardiac Surgery, Bristol Heart Institute, Bristol University, Bristol, GBR
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Same-day discharge after elective percutaneous coronary intervention: A single center experience. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2019.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Rodrigues A, Silva M, Almeida C, Ferreira FC, Morais GPD, Santos L, Melica B, Braga P. Same-day discharge after elective percutaneous coronary intervention: A single center experience. Rev Port Cardiol 2020; 39:443-449. [PMID: 32723680 DOI: 10.1016/j.repc.2019.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/26/2019] [Accepted: 10/12/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Elective percutaneous coronary intervention (PCI) has become an increasingly safe procedure. However, same day discharge (SDD) has yet to become standard practice. Our aim is to characterize the patients who underwent elective PCI and compare outcomes between the overnight stay (ONS) patient group and the group that was discharged on the same day at 24 hours and at 30 days. METHODS One-year registry of patients who underwent an elective PCI. The possibility of SDD was established by the operator. Appropriate candidates were discharged at least four hours after the end of the intervention. The primary endpoints were defined as: Major adverse cardiac and cerebrovascular events (MACCE) - death, myocardial infarction (MI) stroke or transient ischemic attack (TIA), non-planned re-intervention - and vascular complications. Secondary endpoints were any unplanned hospital visit, readmission and re-catheterization. RESULTS We performed 155 elective PCIs. One patient was admitted to the coronary care unit; 111 patients stayed overnight (ONS Group); 43 patients were discharged the same day (SDD Group). Three patients had early (<4 hours) post procedure complications: two TIAs and one vascular access site complication. There were no MACCE between four and 24 hours, nor at 30 days. At 24 hours, two patients from the SDD group had unplanned visits. Between one and 30 days, more patients from the SDD group had unplanned visits (9.3% vs. 0.9%. p=0.02). One patient from the ONS group had a recatherization. There were no readmissions or reinterventions. CONCLUSION Same day discharge of selected patients who undergo elective PCIs is feasible and safe.
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Affiliation(s)
| | - Mariana Silva
- Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Carla Almeida
- Hospital do Divino Espírito Santo de Ponta Delgada, Ponta Delgada, Açores, Portugal
| | | | | | - Lino Santos
- Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Bruno Melica
- Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Pedro Braga
- Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Gokhale S, Desai B, Twing A, Dickens H, Shroff A. Same-Day Discharge After Outpatient PCI in a VA Hospital: Shared Decision Making and the VA MISSION Act. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1369-1373. [PMID: 32513603 DOI: 10.1016/j.carrev.2020.04.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/22/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The VA Mission Act of 2018 sought to increase access to local care facilities for Veterans meeting certain eligibility criteria including a drive time of >60 min from a VA facility. As part of an ongoing review of our VA program's same day discharge (SDD) program following elective percutaneous coronary intervention (PCI), we investigated whether the distance criteria of the VA Mission Act had any impact on overall safety outcomes. METHODS We performed a single center, retrospective study in patients who underwent outpatient PCI between 2013 and 2019. We stratified patients into an overnight observation (ON) and SDD group. We used Google Maps in order to calculate patient home distance to the Jesse Brown Veterans Affairs Hospital (JBVA). Primary endpoints included all-cause death andmajor adverse cardiac events (MACE; cardiovascular death, myocardial infarction, stroke, and/or target vessel revascularization). Secondary outcomes included total unplanned interactions with the healthcare system. Outcomes were analyzed at 30 days after PCI. RESULTS There were 76 patients in the SDD group. The SDD group had a median drive time of 80 min from the JBVA. Regarding primary outcomes, there were no cases of MACE in either group and there was no statistically significant difference in terms of all-cause mortality (ON: 1.3%, SDD: 0%, p = .5) 30 days following PCI. All secondary outcomes at 30 days did not demonstrate a statistically significant difference between either group. CONCLUSION Same day discharge following successful PCI procedures appears safe. In response to the VA Mission Act, drive time and distance travelled did not appear to impact outcomes. SUMMARY Same day discharge in select patients at our VA hospital was both safe and feasible. Neither drive time nor distance travelled affected overall outcomes in response to the 2018 VA MISSION Act. As such, shared decision making between patients and physicians remains essential to ensure Veterans continue to receive high quality care that is in their best medical interest.
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Affiliation(s)
- Sanket Gokhale
- Department of Internal Medicine, University of Illinois-, Chicago, United States of America.
| | - Binnie Desai
- Department of Internal Medicine, University of Illinois-, Chicago, United States of America.
| | - Aamir Twing
- Department of Internal Medicine, University of Illinois-, Chicago, United States of America.
| | - Helena Dickens
- University of Illinois at Urbana-Champaign, United States of America.
| | - Adhir Shroff
- Cardiology Section, University of Illinois-, Chicago, United States of America.
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Basinkevich AB, Matchin YG, Ageev FT. [Safety and clinical-cost effectiveness of percutaneous coronary interventions with overnight hospitalization]. TERAPEVT ARKH 2020; 92:127-134. [PMID: 32598710 DOI: 10.26442/00403660.2020.04.000532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Indexed: 11/22/2022]
Abstract
New methods and treatment plans for patients with chronic coronary artery disease after endovascular interventions are currently introduced into clinical practice. It allows reducing hospital stay down to 24 hour, with discharge the next morning. This approach is called overnight stay. Using a similar strategy increases the availability of various types of endovascular interventions, shorter waiting lists, and cut the cost of treatment due to a reduced hospital stay.
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Affiliation(s)
| | - Y G Matchin
- National Medical Research Center of Cardiology
| | - F T Ageev
- National Medical Research Center of Cardiology
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Mose JN, Kumar NK. The Association Between Structural, Performance, and Community Factors and the Likelihood of Receiving a Penalty Under the Hospital Readmissions Reduction Program (Fiscal Year 2013-2019). Health Equity 2020; 4:129-138. [PMID: 32368711 PMCID: PMC7194327 DOI: 10.1089/heq.2019.0123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: Little is known about the role of structural, performance, and community factors that impact the likelihood of receiving a penalty under the Hospital Readmission Reduction Program. This study examined the association between structural, performance, and community factors and the likelihood of receiving a penalty as well as investigated the likelihood of hospitals serving vulnerable populations of receiving a penalty. Methods: Centers for Medicare and Medicaid Services and United States Census Bureau data were used in this analysis. Ordered logistic regressions in a cross-sectional analysis were employed to estimate the probability of receiving a high or low penalty in the fiscal year 2013 through 2019. Results: On average, medium-sized, major teaching, and safety-net hospitals had the highest proportion of hospitals with a high penalty. After controlling for performance and community factors, structural factor variables such as safety-net status, rural status, and teaching status either were no longer significant or the likelihood magnitude changed. However, after controlling for performance and community factors, the statistical significance of hospital size variables and geographic location persisted across the years. Length of stay and occupancy rate variables were also statistically significant across the 7 years under review. Conclusion: Taken together, structural, performance, and community factors are important in explaining variation in the likelihood of receiving a penalty. There is no evidence that safety-net, rural, and public hospitals are more likely to receive a penalty. The results also suggest that there is room for providers to reduce avoidable readmissions and policymakers to mitigate unintended consequences.
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Affiliation(s)
- Jason N. Mose
- Department of Health Services and Information Management, East Carolina University, Greenville, North Carolina, USA
- Address correspondence to: Jason N. Mose, PhD, MBA, MS, Department of Health Services and Information Management, East Carolina University, 4340H Health Sciences Building, Mailstop 668, Greenville, NC 27858, USA
| | - Neela K. Kumar
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Taxiarchi P, Martin GP, Kinnaird T, Curzen N, Ahmed J, Ludman P, De Belder M, Shoaib A, Rashid M, Kontopantelis E, Mamas MA. Contributors to the Growth of Same Day Discharge After Elective Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2020; 13:e008458. [PMID: 32151162 DOI: 10.1161/circinterventions.119.008458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 12/19/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Financial pressures for reducing hospitalization costs have driven to a move toward same day discharge (SDD) following uncomplicated percutaneous coronary intervention. The UK healthcare system has transitioned to predominantly SDD for elective percutaneous coronary intervention. This study aimed to examine patient's clinical, procedural, and institutional characteristics that are associated with the increased adoption of SDD adoption over time in the United Kingdom and determine whether these vary by region. METHODS The data were derived from the British Cardiovascular Intervention Society including all the elective percutaneous coronary intervention from 2007 to 2014 in the United Kingdom. We structured 8 meaningful groups of variables, and their relative importance was obtained by decomposing the R2 in each study year. RESULTS The relative importance of Strategic Health Authorities was substantially higher than all other factors every year, with some reduction over time, from 49.2% (95% CI, 45.4%-52.4%) in 2007 to 43.4% (95% CI, 39.9%-46.6%) in 2014. Center volume followed with 8.95% (95% CI, 7.0%-10.9%) to 19.8% (95% CI, 16.7%-22.4%). Between patients' clinical and procedural characteristics, pharmacology and access site had the highest relative importance values, from 14.3% (95% CI, 12.1%-16.4%) to 7.1% (95% CI, 5.5%-8.8%) and from 3.6% (95% CI, 2.3%-5.1%) to 11.8% (95% CI, 9.4%-14.3%), respectively. Relative importance of different groups varied differently across Strategic Health Authorities. CONCLUSIONS Growth of SDD was mainly associated with regional characteristics, while subcontributors varied substantially between different regions. Standardized guidelines would provide more homogenous adoption of SDD nationally. This analysis might be of wider interest in healthcare systems slower in SDD adoption.
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Affiliation(s)
- Paraskevi Taxiarchi
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, United Kingdom (P.T., G.P.M.)
| | - Glen P Martin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, United Kingdom (P.T., G.P.M.)
| | - Tim Kinnaird
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.)
- Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, University of Keele (T.K., A.S., M.R., M.A.M.)
| | - Nick Curzen
- Coronary Research Group, University Hospital Southampton, Faculty of Medicine, University of Southampton, United Kingdom (N.C.)
| | - Javed Ahmed
- Department of Cardiology, Freeman Hospital, Newcastle, United Kingdom (J.A.)
| | - Peter Ludman
- Cardiology Department, Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.)
| | - Mark De Belder
- Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.D.B.)
| | - Ahmad Shoaib
- Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, University of Keele (T.K., A.S., M.R., M.A.M.)
- Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, United Kingdom (A.S., M.R., M.A.M.)
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, University of Keele (T.K., A.S., M.R., M.A.M.)
- Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, United Kingdom (A.S., M.R., M.A.M.)
| | - Evangelos Kontopantelis
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, United Kingdom (E.K., M.A.M.)
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, University of Keele (T.K., A.S., M.R., M.A.M.)
- Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, United Kingdom (A.S., M.R., M.A.M.)
- Department of Medicine (Cardiology), Thomas Jefferson University Hospital, Philadelphia, PA (M.A.M.)
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, United Kingdom (E.K., M.A.M.)
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Kok MM, von Birgelen C. Involving the patient's perspective and preferences concerning coronary angiography and percutaneous coronary intervention. EUROINTERVENTION 2020; 15:1228-1231. [PMID: 32044732 DOI: 10.4244/eijv15i14a221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Marlies M Kok
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands
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The Feasibility and Safety of Same-Day Discharge for All Comers after Elective Percutaneous Coronary Interventions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:588-591. [PMID: 31767522 DOI: 10.1016/j.carrev.2019.09.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 09/28/2019] [Accepted: 09/30/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The safety of same day discharge (SDD) after percutaneous coronary interventions (PCI) has been demonstrated in several studies. However, SDD was only allowed in patients meeting strict criteria. We aimed to evaluate the feasibility and safety of SDD following elective-PCI in all comers. METHODS In 2012, we implemented a strategy of SDD for all elective PCI (no exclusion) but admissions were allowed at the discretion of the treating physician. We assessed the feasibility and safety of this approach in consecutive patients who underwent elective PCI at WVU. RESULTS Out of 3355 patients who underwent PCI between 2012 and 2016, 691 (21%) presented electively. Radial access was utilized in 480 (69.5%). Same day discharge was achieved in 539/691 (78%), and there was no difference between patients who had SDD and those who were admitted with regards to the 30-day major adverse cardiovascular and cerebrovascular events (3.2% vs. 3.5% respectively, P = 0.195). Predictors of SDD failure were procedural complications (OR 12.08, 95%CI 2.20-57.8. P = 0.002), use of Glycoprotein IIB-IIIA inhibitors (OR 3.45, 95%CI 1.067-11.41, P = 0.039), femoral access (OR 2.067, 95%CI 1.25-3.419, p = 0.005), anemia (OR 1.80, 95%CI 1.06-3.04, P = 0.029), home distance ≥60 miles (OR 1.68, 95%CI 1.03-2.72, P = 0.037). CONCLUSION SDD is feasible in the majority of all-comers after elective PCI, and is not associated with increase in adverse events at 30-days. Certain procedural and patient's characteristics predict SDD failure. If validated in prospective studies, these factors can possibly be integrated in a predictive tool to aid in triaging patients, post-elective PCI.
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32
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Same-Day Discharge After Elective Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2019; 12:1479-1494. [DOI: 10.1016/j.jcin.2019.03.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/22/2019] [Accepted: 03/26/2019] [Indexed: 11/17/2022]
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Abstract
See Article Madan et al.
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Affiliation(s)
- Kunal Patel
- University of Texas Southwestern Medical CenterDallasTX
| | - Subhash Banerjee
- University of Texas Southwestern Medical CenterDallasTX
- Veterans Affairs North Texas Health Care SystemDallasTX
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Rubimbura V, Rostain L, Duval AM, Akakpo S, Boukantar M, Boiron P, Mouillet G, Gallet R, Belarbi A, Le Corvoisier P, Dubois-Randé JL, Teiger E. Outcomes and safety of same-day discharge after percutaneous coronary intervention: A 10-year single-center study. Catheter Cardiovasc Interv 2019; 94:105-111. [PMID: 30702204 DOI: 10.1002/ccd.28084] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/27/2018] [Accepted: 12/31/2018] [Indexed: 02/05/2023]
Abstract
AIMS Same-day discharge (SDD) after percutaneous coronary intervention (PCI) was safe and cost-effective in randomized and observational studies but faces limited acceptance due to concerns about early adverse events. Our aim was to evaluate early outcomes after SDD PCI in a high-volume urban PCI center over 10 years. METHODS AND RESULTS From 2007 to 2016, 1,635 unselected patients had PCI at our ambulatory cardiac care unit, mainly for stable ischemic heart disease (SIHD). Among them, 1,073 (65.6%), most of whom underwent ad hoc PCI, were discharged on the same day and 562 (34.4%) were admitted, for adverse events during PCI (n = 60) or within the next 4-6 hr (n = 52) or chiefly due to physician preference (n = 450). In the SDD group, radial access was used in 98.5% of patients; 36% and 15% of patients had two- and three-vessel disease, respectively; and two-vessel PCI was performed in 11% of patients. No MACCEs (death, myocardial infarction, stroke, urgent repeat PCI/CABG, and major vascular complications) occurred within 24 hr post-discharge. Two patients were readmitted on the next day for chest pain but did not require repeat PCI. CONCLUSION SDD after successful PCI without complications within the next 4-6 hr is safe and feasible in most patients with SIHD. Among 1,035 SDD patients treated over 10 years, only two required readmission, and none experienced major cardiac adverse events such as death or stent thrombosis. SDD is safe for the patient and cost-effective for the healthcare system and should be implemented more widely.
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Affiliation(s)
- Vladimir Rubimbura
- Interventional Cardiology Unit, Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Laura Rostain
- Interventional Cardiology Unit, Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Anne-Marie Duval
- Department of Cardiology, Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Servais Akakpo
- Department of Cardiology, Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Madjid Boukantar
- Interventional Cardiology Unit, Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Philippe Boiron
- Interventional Cardiology Unit, Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Gauthier Mouillet
- Interventional Cardiology Unit, Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Romain Gallet
- Interventional Cardiology Unit, Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Abdelkaoui Belarbi
- Interventional Cardiology Unit, Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France
| | | | - Jean-Luc Dubois-Randé
- Department of Cardiology, Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France.,Inserm, CIC 1430 et U955 team 3, Henri Mondor University Hospital, Créteil, France
| | - Emmanuel Teiger
- Interventional Cardiology Unit, Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France.,Inserm, CIC 1430 et U955 team 3, Henri Mondor University Hospital, Créteil, France
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Córdoba-Soriano JG, Rivera-Juárez A, Gutiérrez-Díez A, Gutiérrez-Ibañes E, Gallardo-López A, Samaniego-Lampón B, Lozano I, Melehi D, Portero-Portaz JJ, Elízaga J, Jiménez-Mazuecos J. The Feasibility and Safety of Ambulatory Percutaneous Coronary Interventions in Complex Lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:875-882. [PMID: 30639420 DOI: 10.1016/j.carrev.2018.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 12/05/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The safety and feasibility of ambulatory PCI has been demonstrated in selected patients with "simple" lesions, but it is not well known whether it could be applied in more "complex" scenarios. METHODS Main objective is to assess the feasibility and safety of ambulatory complex PCI. Prospective multicentre registry of 1047 consecutive patients planned for ambulatory trans-radial PCI. Outcomes in patients with "complex angioplasty" (CA group: 313 (30%)) were analysed and compared with those of "simple angioplasty" (SA group: 734, 70%). The feasibility (% of patients finally discharged) and safety (MACE at 24 h and at 1 month) were compared between groups. We also analyse admissions, visits to the emergency department and minor vascular complications. RESULTS Feasibility was higher for SA (80.6% vs. 63.6%, OR 1.89, 95% CI 1.52-2.35, p < 0.001). Ambulatory PCI was very safe in both groups. In CA no MACE occurred at 24 h (vs. 0.17% SA) or 30 days (vs. 0.68% in SA). There were also no differences in re-admissions, visits to the emergency department or minor vascular complications (there was a non-significant tendency to higher rate of radial occlusion at 1 month in the CA group, 5.5% vs. 2.7%, p: 0.07). CONCLUSIONS The feasibility of ambulatory PCI in selected patients with complex lesions is lower than in simple lesions, however when it is possible, it is as safe as in selected patients with simple lesions.
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Affiliation(s)
| | | | | | | | | | | | - Iñigo Lozano
- Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - Driss Melehi
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | - Jaime Elízaga
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Lu H, Guan W, Zhou Y, Bao H. Early versus late clinical outcomes following same day discharge after elective percutaneous coronary intervention: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e14025. [PMID: 30608455 PMCID: PMC6344175 DOI: 10.1097/md.0000000000014025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Nowadays 57% of the cardiologists based in the United Kingdom and 32% of the cardiologists based in Canada utilize same day discharge (SDD) following elective percutaneous coronary intervention (PCI) as a routine practice. In this analysis, we aimed to systematically assess early versus late clinical outcomes following SDD after elective PCI. METHODS The Medical Literature Analysis and Retrieval System Online, the Cochrane Central, the Resources from the United States National Library of Medicine (www.ClinicalTrials.gov: http://www.clinicaltrials.gov) and EMBASE were carefully searched for relevant English publications which reported early versus late clinical outcomes in patients who were discharged on the same day following revascularization by PCI. Relevant clinical outcomes which were reported in the original studies were considered as the endpoints in this analysis. Odd ratios (OR) and 95% confidence intervals (CI) were used to represent the data, and RevMan 5.3 was used as the statistical software. RESULTS A total number of 21, 687 participants (enrollment time period from the year 1998 to the year 2015) were assigned to this analysis. When early versus late clinical outcomes were compared in patients who were discharged on the same day following elective PCI, major adverse cardiac events (OR: 0.75, 95% CI: 0.31-1.79; P = .51), mortality (OR: 0.26, 95% CI: 0.06-1.06; P = .06), stroke (OR: 1.46, 95% CI: 0.72-2.94; P = .29), arrhythmia (OR: 1.30, 95% CI: 0.64-2.63; P = .47), hematoma (OR: 1.00, 95% CI: 0.60-1.66; P = 1.00) and major bleeding from access site (OR: 1.68, 95% CI: 0.22-12.85; P = .62) were not significantly different. Post-procedural myocardial infarction (OR: 2.01, 95% CI: 0.71-5.70; P = .19) and minor bleeding from access site (OR: 6.61, 95% CI: 0.86-50.66; P = .07) were also similarly manifested. However, re-hospitalization was significantly higher in those patients with late clinical outcomes (OR: 0.18, 95% CI: 0.07-0.44; P = .0002). CONCLUSIONS In those patients who were discharged from the hospital on the same day following elective PCI, no significant difference was observed in the assessed early versus late clinical outcomes. However, late clinical outcomes resulted in a significantly higher rate of re-hospitalization. Larger studies should confirm this hypothesis.
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Affiliation(s)
- Hongtao Lu
- Jingzhou Central Hospital of Cardiology, The Second Clinical Medical College, Yangtze University, Jingzhou
| | - Wenjun Guan
- Jingzhou Central Hospital of Cardiology, The Second Clinical Medical College, Yangtze University, Jingzhou
| | - Yanhua Zhou
- Jingzhou First People's Hospital, the First Clinical Medical College
| | - Hong Bao
- Jiangling County People's Hospital of Cardiology, Jingzhou, Hubei, People's Republic of China
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Agarwal S, Thakkar B, Skelding KA, Blankenship JC. Trends and Outcomes After Same-Day Discharge After Percutaneous Coronary Interventions. Circ Cardiovasc Qual Outcomes 2018; 10:CIRCOUTCOMES.117.003936. [PMID: 28794119 DOI: 10.1161/circoutcomes.117.003936] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 07/06/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite the demonstrated safety of the same-day discharge (SDD) after percutaneous coronary intervention (PCI), uptake of this program has been relatively poor in the United States. We evaluated the temporal trends and variations in the utilization of SDD after PCI during the contemporary era. In addition, we evaluated the predictors of SDD (compared with next-day discharge) and the causes of readmission in these 2 patient cohorts. METHODS AND RESULTS Data were extracted from State Ambulatory Surgical Database and State Inpatient Database from Florida and New York ranging from 2009 to 2013. All adults undergoing PCI in an outpatient setting were included. Data were merged with the directory available from the American Hospital Association to obtain detailed information on hospital-related characteristics. Unplanned readmissions within 7 and 30 days constituted the coprimary outcomes. There was modest increase in the proportion of SDD after PCI from 2.5% in 2009 to 7.4% in 2013 (P-trend <0.001). SDD was more frequently used among male and younger patients with fewer comorbidities. There were considerable differences in the discharge practices among the different hospital types. Larger hospitals, teaching hospitals, and high PCI volume hospitals had higher utilization of SDD compared with their respective counterparts. SDD and next-day discharge cohorts had similar rates of unplanned readmissions, in-hospital mortality, and acute myocardial infarction during follow-up. Furthermore, uninsured patients had significantly lower odds of SDD along with higher incidence of unplanned readmission within 30 days after PCI compared with insured patients. CONCLUSIONS During 2009 to 2013, there has been a modest increase in SDD after PCI. Several demographic and clinical characteristics play critical role in determination of SDD after PCI. There were significant disparities in discharge practices between different sex, racial, and insurance-based strata.
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Affiliation(s)
- Shikhar Agarwal
- From the Department of Cardiology, Section of Interventional Cardiology, Geisinger Medical Center, Danville, PA (S.A., K.A.S., J.C.B.); and Division of Internal Medicine, Rutgers New Jersey Medical School, Newark (B.T.).
| | - Badal Thakkar
- From the Department of Cardiology, Section of Interventional Cardiology, Geisinger Medical Center, Danville, PA (S.A., K.A.S., J.C.B.); and Division of Internal Medicine, Rutgers New Jersey Medical School, Newark (B.T.)
| | - Kimberly A Skelding
- From the Department of Cardiology, Section of Interventional Cardiology, Geisinger Medical Center, Danville, PA (S.A., K.A.S., J.C.B.); and Division of Internal Medicine, Rutgers New Jersey Medical School, Newark (B.T.)
| | - James C Blankenship
- From the Department of Cardiology, Section of Interventional Cardiology, Geisinger Medical Center, Danville, PA (S.A., K.A.S., J.C.B.); and Division of Internal Medicine, Rutgers New Jersey Medical School, Newark (B.T.)
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Seto AH, Shroff A, Abu-Fadel M, Blankenship JC, Boudoulas KD, Cigarroa JE, Dehmer GJ, Feldman DN, Kolansky DM, Lata K, Swaminathan RV, Rao SV. Length of stay following percutaneous coronary intervention: An expert consensus document update from the society for cardiovascular angiography and interventions. Catheter Cardiovasc Interv 2018; 92:717-731. [DOI: 10.1002/ccd.27637] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 03/23/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Arnold H. Seto
- Department of Medicine; Long Beach Veterans Affairs Healthcare System, Long Beach, California
| | - Adhir Shroff
- Department of Medicine; University of Illinois at Chicago, Chicago, Illinois
| | - Mazen Abu-Fadel
- Department of Internal Medicine, Section of Cardiovascular Medicine; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - James C. Blankenship
- Department of Cardiology, Section of Interventional Cardiology; Geisinger Medical Center, Danville, Pennsylvania
| | | | - Joaquin E. Cigarroa
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Gregory J. Dehmer
- Department of Medicine (Cardiology Division) Texas A&M University College of Medicine; Scott & White Medical Center; Temple Texas
| | - Dmitriy N. Feldman
- New York-Presbyterian Hospital; Weill Cornell Medical College; New York New York
| | - Daniel M. Kolansky
- Cardiovascular Medicine Division; University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kusum Lata
- Sutter Tracy Community Hospital, Sutter Medical Network, Tracy, California
| | | | - Sunil V. Rao
- Division of Cardiology; Duke Clinical Research Institute, Durham, North Carolina
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Amin AP, Crimmins-Reda P, Miller S, Rahn B, Caruso M, Pierce A, Dennis B, Pendegraft M, Sorensen K, Kurz HI, Lasala JM, Zajarias A, Bach RG, Kulkarni H, Singh J. Novel Patient-Centered Approach to Facilitate Same-Day Discharge in Patients Undergoing Elective Percutaneous Coronary Intervention. J Am Heart Assoc 2018; 7:JAHA.117.005733. [PMID: 29449273 PMCID: PMC5850176 DOI: 10.1161/jaha.117.005733] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Same‐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 Results Our 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. Conclusions With 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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Affiliation(s)
- Amit P Amin
- Cardiovascular Division, Washington University School of Medicine, St Louis, MO .,Center for Value and Innovation, Washington University School of Medicine, St Louis, MO.,Barnes-Jewish Hospital, St Louis, MO
| | - Patricia Crimmins-Reda
- Center for Value and Innovation, Washington University School of Medicine, St Louis, MO.,Barnes-Jewish Hospital, St Louis, MO
| | | | - Brandon Rahn
- Center for Value and Innovation, Washington University School of Medicine, St Louis, MO.,Barnes-Jewish Hospital, St Louis, MO
| | - Mary Caruso
- Center for Value and Innovation, Washington University School of Medicine, St Louis, MO.,Barnes-Jewish Hospital, St Louis, MO
| | | | - Brandy Dennis
- Cardiovascular Division, Washington University School of Medicine, St Louis, MO.,Center for Value and Innovation, Washington University School of Medicine, St Louis, MO
| | - Marissa Pendegraft
- Cardiovascular Division, Washington University School of Medicine, St Louis, MO.,Center for Value and Innovation, Washington University School of Medicine, St Louis, MO
| | - Katrine Sorensen
- Cardiovascular Division, Washington University School of Medicine, St Louis, MO
| | - Howard I Kurz
- Cardiovascular Division, Washington University School of Medicine, St Louis, MO.,Barnes-Jewish Hospital, St Louis, MO
| | - John M Lasala
- Cardiovascular Division, Washington University School of Medicine, St Louis, MO.,Barnes-Jewish Hospital, St Louis, MO
| | - Alan Zajarias
- Cardiovascular Division, Washington University School of Medicine, St Louis, MO.,Barnes-Jewish Hospital, St Louis, MO
| | - Richard G Bach
- Cardiovascular Division, Washington University School of Medicine, St Louis, MO.,Barnes-Jewish Hospital, St Louis, MO
| | | | - Jasvindar Singh
- Cardiovascular Division, Washington University School of Medicine, St Louis, MO.,Barnes-Jewish Hospital, St Louis, MO
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Agarwal S. Impact of Travel Time on Same-Day Discharge after Elective Percutaneous Coronary Intervention. Tex Heart Inst J 2017; 44:431. [PMID: 29276448 DOI: 10.14503/thij-17-6467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Shikhar Agarwal
- Department of Cardiology, Geisinger Medical Center, Danville, Pennsylvania
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41
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Seguridad y factibilidad de la intervención coronaria percutánea ambulatoria en pacientes seleccionados: datos de un registro multicéntrico español. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.09.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Koutouzis M, Karatasakis A, Brilakis ES, Agelaki M, Maniotis C, Dimitriou P, Lazaris E. Feasibility and safety of same-day discharge after complex percutaneous coronary intervention using forearm approach. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:245-249. [DOI: 10.1016/j.carrev.2017.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 01/29/2017] [Accepted: 02/02/2017] [Indexed: 11/30/2022]
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Kok MM, Weernink MGM, von Birgelen C, Fens A, van der Heijden LC, van Til JA. Patient preference for radial versus femoral vascular access for elective coronary procedures: The PREVAS study. Catheter Cardiovasc Interv 2017; 91:17-24. [PMID: 28470994 PMCID: PMC5811812 DOI: 10.1002/ccd.27039] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 01/05/2017] [Accepted: 02/25/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To explore patient preference for vascular access site in percutaneous coronary procedures, the perceived importance of benefits and risks of transradial access (TRA) and transfemoral access (TFA) were assessed. In addition, direct preference for vascular access and preference for shared decision making (SDM) were evaluated. BACKGROUND TRA has gained significant ground on TFA during the last decades. Surveys on patient preference have mostly been performed in dedicated TRA trials. METHODS In the PREVAS study (Clinicaltrials.gov: NCT02625493) a stated preference elicitation method best-worst scaling (BWS) was used to determine patient preference for six treatment attributes: bleeding, switch of access-site, postprocedural vessel quality, mobilization and comfort, and over-night stay. Based on software-generated treatment scenarios, 142 patients indicated which characteristics they perceived most and least important in treatment choice. Best-minus-Worst scores and attribute importance were calculated. RESULTS Bleeding risk was considered most important (attribute importance 31.3%), followed by length of hospitalization (22.6%), and mobilization(20.2%). Most patients preferred the approach of their current procedure (85.9%); however, 71.1% of patients with experience with both access routes favored TRA (P < 0.001). Most patients (38.0%) appreciated SDM, balanced between patient and cardiologist. CONCLUSIONS Patients appreciate lower bleeding risk and early ambulation, factors favoring TRA. Previous experience with a single access route has a major impact on preference, while experience with both routes generally resulted in preference for TRA. Most patients prefer balanced SDM. © 2017 The Authors Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Marlies M Kok
- Thoraxcentrum Twente, Department of Cardiology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Marieke G M Weernink
- Department of Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Clemens von Birgelen
- Thoraxcentrum Twente, Department of Cardiology, Medisch Spectrum Twente, Enschede, the Netherlands.,Department of Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Anneloes Fens
- Department of Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Liefke C van der Heijden
- Thoraxcentrum Twente, Department of Cardiology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Janine A van Til
- Department of Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
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44
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Din JN, Snow TM, Rao SV, Klinke WP, Nadra IJ, Della Siega A, Robinson SD. Variation in practice and concordance with guideline criteria for length of stay after elective percutaneous coronary intervention. Catheter Cardiovasc Interv 2017; 90:715-722. [DOI: 10.1002/ccd.26992] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 12/20/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Jehangir N. Din
- Victoria Heart Institute Foundation; Victoria British Columbia Canada
- Dorset Heart Centre, Royal Bournemouth Hospital; Bournemouth United Kingdom
| | - Thomas M. Snow
- Dorset Heart Centre, Royal Bournemouth Hospital; Bournemouth United Kingdom
| | - Sunil V. Rao
- Duke Clinical Research Institute; Durham North Carolina
| | - W. Peter Klinke
- Victoria Heart Institute Foundation; Victoria British Columbia Canada
| | - Imad J. Nadra
- Victoria Heart Institute Foundation; Victoria British Columbia Canada
- Royal Jubilee Hospital; Victoria British Columbia Canada
| | - Anthony Della Siega
- Victoria Heart Institute Foundation; Victoria British Columbia Canada
- Royal Jubilee Hospital; Victoria British Columbia Canada
| | - Simon D. Robinson
- Victoria Heart Institute Foundation; Victoria British Columbia Canada
- Royal Jubilee Hospital; Victoria British Columbia Canada
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Abdelnoor M, Andersen JG, Arnesen H, Johansen O. Early discharge compared with ordinary discharge after percutaneous coronary intervention - a systematic review and meta-analysis of safety and cost. Vasc Health Risk Manag 2017; 13:101-109. [PMID: 28356750 PMCID: PMC5367460 DOI: 10.2147/vhrm.s122951] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Aim We aimed to summarize the pooled effect of early discharge compared with ordinary discharge after percutaneous coronary intervention (PCI) on the composite endpoint of re-infarction, revascularization, stroke, death, and incidence of rehospitalization. We also aimed to compare costs for the two strategies. Methods The study was a systematic review and a meta-analysis of 12 randomized controlled trials including 2962 patients, followed by trial sequential analysis. An estimation of cost was considered. Follow-up time was 30 days. Results For early discharge, pooled effect for the composite endpoint was relative risk of efficacy (RRe)=0.65, 95% confidence interval (CI) (0.52–0.81). Rehospitalization had a pooled effect of RRe=1.10, 95% CI (0.88–1.38). Early discharge had an increasing risk of rehospitalization with increasing frequency of hypertension for all populations, except those with stable angina, where a decreasing risk was noted. Advancing age gave increased risk of revascularization. Early discharge had a cost reduction of 655 Euros per patient compared with ordinary discharge. Conclusion The pooled effect supports the safe use of early discharge after PCI in the treatment of a heterogeneous population of patients with coronary artery disease. There was an increased risk of rehospitalization for all subpopulations, except patients with stable angina. Clinical trials with homogeneous populations of acute coronary syndrome are needed to be conclusive on this issue.
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Affiliation(s)
- Michael Abdelnoor
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway; Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Jack Gunnar Andersen
- Clinic of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway; Department of Health Management and Health Economics, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Harald Arnesen
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo Norway
| | - Odd Johansen
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
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Safety and Feasibility of Outpatient Percutaneous Coronary Intervention in Selected Patients: A Spanish Multicenter Registry. ACTA ACUST UNITED AC 2017; 70:535-542. [PMID: 28254362 DOI: 10.1016/j.rec.2017.01.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 09/26/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES The exponential increase in coronary interventions plus the generalization of the radial approach represent the ideal scenario for starting outpatient angioplasty programs with the aim of reducing the costs while maintaining safety. This article reports data from a multicenter Spanish registry on fully ambulatory transradial angioplasty in selected patients for the first time. METHODS Prospective registry of elective outpatient transradial-ulnar angioplasty in patients with stable coronary disease. Patients were discharged the same day and were followed up at 24hours and 30 days. Safety and feasibility were analyzed. RESULTS Of the 723 patients included (76% male; age, 66.6±10.5 years), 533 (73.7%) were finally discharged after 4 to 12hours of surveillance. Among the remaining 190 (26.7%) patients, the most common reason for hospitalization was clinical instability after the procedure (60.5%). Independent predictors of admission were a history of peripheral artery disease, a higher baseline creatinine level, ad hoc performance of the procedure, and multivessel disease. At 24hours, there was 1 major adverse event in 1 patient (0.19%), who required hospitalization for major bleeding not related to vascular access. At 30 days, there were 3 major adverse events (0.56%): 1 subacute stent thrombosis, 1 revascularization of a vessel other than the treated vessel, and 1 minor stroke. Eight patients (1.5%) required admission at 30 days. CONCLUSIONS The application of an outpatient transradial-ulnar angioplasty program with discharge after 4 to 12 hours' surveillance is safe and feasible in well-selected patients.
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Bundhun PK, Soogund MZS, Huang WQ. Same Day Discharge versus Overnight Stay in the Hospital following Percutaneous Coronary Intervention in Patients with Stable Coronary Artery Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS One 2017; 12:e0169807. [PMID: 28068415 PMCID: PMC5222585 DOI: 10.1371/journal.pone.0169807] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 12/21/2016] [Indexed: 12/31/2022] Open
Abstract
Background New research in interventional cardiology has shown the demand for percutaneous coronary interventions (PCI) to have increased tremendously. Effective treatment with a lower hospital cost has been the aim of several PCI capable centers. This study aimed to compare the adverse clinical outcomes associated with same day discharge versus overnight stay in the hospital following PCI in a population of randomized patients with stable coronary artery disease (CAD). Methods The National Library of Medicine (MEDLINE/PubMed), the Cochrane Registry of Randomized Controlled Trials and EMBASE databases were searched (from March to June 2016) for randomized trials comparing same-day discharge versus overnight stay in the hospital following PCI. Main endpoints in this analysis included adverse cardiovascular outcomes observed during a 30-day period. Statistical analysis was carried out by the RevMan 5.3 software whereby odds ratios (OR) and 95% confidence intervals (CIs) were calculated with respect to a fixed or a random effects model. Results Eight randomized trials with a total number of 3081 patients (1598 patients who were discharged on the same day and 1483 patients who stayed overnight in the hospital) were included. Results of this analysis showed that mortality, myocardial infarction (MI) and major adverse cardiac events (MACEs) were not significantly different between same day discharge versus overnight stay following PCI with OR: 0.22, 95% CI: 0.04–1.35; P = 0.10, OR: 0.68, 95% CI: 0.33–1.41; P = 0.30 and OR: 0.45, 95% CI: 0.20–1.02; P = 0.06 respectively. Blood transfusion and re-hospitalization were also not significantly different between these two groups with OR: 0.64, 95% CI: 0.13–3.21; P = 0.59 and OR: 1.53, 95% CI: 0.88–2.65; P = 0.13 respectively. Similarly, any adverse event, major bleeding and repeated revascularization were also not significantly different between these two groups of patients with stable CAD, with OR: 0.42, 95% CI: 0.05–3.97; P = 0.45, OR: 0.73, 95% CI: 0.15–3.54; P = 0.69 and OR: 0.67, 95% CI: 0.14–3.15; P = 0.61 respectively. Conclusion In terms of adverse cardiovascular outcomes, same day discharge was neither superior nor inferior to overnight hospital stay following PCI in those patients with stable CAD. However, future research will have to emphasize on the long-term consequences.
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Affiliation(s)
- Pravesh Kumar Bundhun
- Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, P. R. China
| | | | - Wei-Qiang Huang
- Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, P. R. China
- * E-mail:
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Zanaty M, Daou B, Chalouhi N, Starke RM, Samaniego E, Derdeyn C, Jabbour P, Hasan D. Same-Day Discharge After Treatment with the Pipeline Embolization Device Using Monitored Anesthesia Care. World Neurosurg 2016; 96:31-35. [PMID: 27565476 DOI: 10.1016/j.wneu.2016.08.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/10/2016] [Accepted: 08/12/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The Pipeline Embolization Device (PED) has been used and shown to be safe under monitored anesthesia care (MAC). We present the results of the first study, to our knowledge, assessing the safety and feasibility of same-day discharge in patients undergoing treatment with the PED, using MAC. METHODS A total of 130 patients with 143 cerebral aneurysms (CAs) were identified. Patients were treated under MAC with the PED. All of the patients were counseled preoperatively about the elective nature of the procedure and the same-day discharge. RESULTS The mean age of the participants was 60.7 ± 12.12 years. Men constituted 27.69% (36/130) of the population. The number of procedures was 138. All of our patients elected to return home the same day, whereas only 6.15% (8/130) of them changed their mind in the postoperative setting and elected to stay overnight out of convenience (late discharge, patient preference, or living alone at home). Overall discharge home on the same day occurred after 90.6% of procedures (125/138) and in 91.53% (119/130) of the patients. All same-day discharges took place within 4-6 hours after the procedures. The rate of major complications was 0.75% (1/134). The mortality rate was 0%. CONCLUSIONS PED treatment under MAC is feasible and safe. This has brought forth an era of outpatient treatment of CAs where patients are discharged home 6 hours after the procedure.
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Affiliation(s)
- Mario Zanaty
- Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Badih Daou
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Nohra Chalouhi
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Robert M Starke
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Edgar Samaniego
- Department of Neurology and Interventional Radiology, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Colin Derdeyn
- Department of Radiology and Interventional Radiology, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - David Hasan
- Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA.
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Chen Y, Marshall A, Lin F. Implementation Strategies for Same Day Discharge Post Percutaneous Coronary Intervention: An Integrative Review. Worldviews Evid Based Nurs 2016; 13:371-379. [PMID: 27171576 DOI: 10.1111/wvn.12163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Same day discharge following percutaneous coronary intervention has emerged worldwide to enhance discharge efficiency and decrease length of stay. However, uptake of this practice is variable and strategies to support its implementation have not been examined. RESEARCH QUESTION Among patients who undergo nonurgent percutaneous coronary intervention, what components are included in and which strategies are used to facilitate the implementation of same day discharge in clinical practice? METHODS An integrative review was conducted. Keywords including same day discharge, outpatient, percutaneous coronary intervention, outpatient coronary stenting were used to search databases including Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica dataBase, Cochrane, and Medline between 1990 and 2014. Data were extracted and summarized specific to: (a) components of same day discharge, (b) patient selection, and (c) strategies used to implement same day discharge. RESULTS Nineteen articles were included that provided information about implementation strategies for same day discharge. Variability was identified in how same day discharge was operationalized, how patients were selected, and the strategies that were used to implement same day discharge. Culture, patient preference, and acceptance of same day discharge were important for its implementation. Guideline or protocol, physical environment, champion, education, audit or feedback, and team building were all found to be important strategies in implementing same day discharge. LINKING EVIDENCE TO ACTION The results of this integrative review inform our understanding of how same day discharge is operationalized and what strategies can be used to implement same day discharge. The findings of the review highlight that there is a need for more research examining implementation strategies in a detailed manner that can assist others to introduce and sustain same day discharge in routine practice.
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Affiliation(s)
- Yingyan Chen
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Southport, QLD, Australia.
| | - Andrea Marshall
- Professor of Acute and Complex Care Nursing, School of Nursing and Midwifery; NHMRC Centre of Research Excellence in Nursing Interventions for Hospitalized Patients (NCREN), Menzies Health Institute Queensland; Gold Coast Hospital and Health Service, Nursing and Midwifery Education and Research Unit, all at Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | - Frances Lin
- Program Director, Senior Lecturer, School of Nursing and Midwifery, and Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
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50
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Affiliation(s)
- Harold L Dauerman
- From the Department of Medicine, University of Vermont College of Medicine, Burlington
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