Cost-Effectiveness of Early Discharge (<48 Hours) for Low-Risk Patients Following PPCI for STEMI

作者：Krishnaraj S. Rathod, Katrina Comer, Oliver Casey-Gillman, Lizzie Moore, Sotiris Antoniou, Sadeer Fhadil, Paul Wright, Jennifer Mather, Michelle Che Ting Yick, Rohan Vyas, Roy B. Wang, Muhiddin Ozkor, Oliver Guttmann, Andreas Baumbach, Andrew Archbold, Andrew Wragg, Ajay Jain, Fizzah Choudry, Anthony Mathur, Daniel A. Jones · 发表于：JACC: Cardiovascular Interventions · 年份：2025 · DOI：10.1016/j.jcin.2025.04.045 · 被引用次数：5 · 研究领域：Acute Myocardial Infarction Research、Heart Failure Treatment and Management、Coronary Interventions and Diagnostics

BACKGROUND: Early discharge after primary percutaneous coronary intervention can increase the efficiency of health care, enabling cost savings. Dedicated virtual follow-up pathways can provide remote diagnostic information to aid earlier discharge, optimize care and reduce unplanned readmissions. OBJECTIVES: The aims of this study were: 1) to review the long-term (1-year) safety of early hospital discharge (<48 hours) after ST-segment elevation myocardial infarction; 2) to assess the effect of virtual follow-up on medication adherence and ability to up-titrate secondary prevention medication; and 3) to determine the cost-effectiveness of a virtual follow-up pathway after early discharge. METHODS: Between April 2020 and March 2023, 1,500 low-risk patients were discharged at <48 hours and placed on the early hospital discharge follow-up pathway. Patients were reviewed by structured virtual follow-up at 48 hours; 2, 4, and 8 weeks; and 3 and 12 months. RESULTS: The median length of hospital stay was 24.9 hours (Q1-Q3: 22.8-36.4 hours), with a minimum of 17 hours and a maximum of 40 hours. Seventy-three percent of patients (1,095 of 1,500) stayed 1 fewer night in the hospital compared with normal pathways. The median length of stay for the control group was 68.1 hours (Q1-Q3: 56-80 hours) (P < 0.0001). During 12-month follow-up, there was a low major adverse cardiac event rate of 3.1% (47 of 1,500) including 0.6% (9 of 1,500) for all-cause mortality and 0.13% (2 of 1,500) for car...