Centers venture into same-day discharge after ICD placement

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Same-day discharge with elective PCIs has picked up steam in recent years. Now it looks like same-day elective implantable cardioverter-defibrillator (ICD) implantation could follow suit.

In a study published March 10 in the Journal of the American College of Cardiology, Paul L. Hess, MD, of the Duke Clinical Research Institute in Durham, N.C., and colleagues reported on trends in elective ICD placement between 2006 and 2009. They linked data from the National Cardiovascular Data Registry’s ICD Registry and Medicare claims for their analysis.

Of the study sample of 58,195 patients, hospitals discharged 5.3 percent on the same day as their ICD placement. The majority of the 1,314 facilities (64 percent) did not perform same-day discharges, although 2 percent had same-day discharge rates of 50 percent or higher.

Those hospitals that did same-day discharges were more likely to be private practice rather than academic hospitals, and more likely to be in suburban areas than in rural areas.

Overall, the practice of same-day discharge ticked up over the study period, from 4.1 percent in 2006 to 6.6 percent in 2009.

The researchers found no significant difference between same-day discharge and overnight stays in the rates of death, all-cause readmissions and device-related readmissions at 90 days after discharge.

“For appropriate patients, a new practice model may incorporate novel care processes but not require overnight observation, particularly if the patient undergoes ICD placement early in the day,” Hess et al wrote. That protocol might include close monitoring after implantation, getting in the follow-up chest x-ray and device interrogation, educating patients and outpatient follow-up.

They suggested medical societies or hospitals should develop standardized criteria for selecting same-day discharge ICD patients. As has been shown with some same-day PCI discharge programs, same-day ICD placement might free up hospital beds, reduce costs and raise patient satisfaction, they added.