How to send more low-risk STEMI patients home early after PCI

Researchers have developed a new four-step protocol to determine when ST-elevation myocardial infarction (STEMI) patients can be discharged early after percutaneous coronary intervention (PCI). The team shared its findings in the Canadian Journal of Cardiology.

“Earlier hospital discharge in low-risk patients presenting with STEMI has been an area of focus in an attempt to reduce healthcare costs,” wrote lead author Jeffrey A. Marbach, MBBS, MS, from the University of Ottawa Heart Institute (UOHI), and colleagues. “As a result, discharge within 48-72 hours following successful primary PCI has increasingly become routine practice. Moreover, the current COVID-19 pandemic has led to enormous pressure on healthcare systems to find ways to increase bed-capacity, preserve resources, and reduce the risk of exposure to patients and healthcare workers.”

Marbach et al. created and implemented the Very Early Hospital Discharge (VEHD) protocol to “reduce hospital length-of-stay and free up limited hospital resources” during these especially challenging times.

Step 1 of the protocol is confirming the patient meets all eligibility criteria that the authors have established. The patient must be younger than 75 years old, for instance, and have no history of prior stroke or cardiac arrest.

Step 2 is enrolling the patient in the VEHD program and completing all necessary pre-discharge tasks.

“Specific pre-discharge tasks are assigned to either the attending physician/primary medical team or the patient’s nurse,” the authors wrote. “Once all of these tasks have been completed and signed-off in the electronic medical record, the patient can be discharged home.”

Step 3, meanwhile, consists of follow-up phone calls between the patient and a “a trained telehealth nurse.” These calls occur 48 hours, seven days and 30 days after discharge, and they give the patient the opportunity to ask any questions that they may have.

And step 4, the final step, includes an outpatient visit—either done in person or virtually—by the interventional cardiologist who first performed the PCI.

The research team did validate its protocol prior to implementation using data from more than 4,000 patients taken from the UOHI STEMI database. Overall, the authors found that in-hospital death and major cardiovascular events dropped when using the VEHD algorithm from 5.1% and 6.9%, respectively, to 0.29% and 0.70%. The median length-of-stay was also one day shorter, a move that can certainly help keep healthcare costs down.

“While the COVID-19 pandemic was the impetus for introducing the VEHD protocol, the available literature, in addition to our initial data, suggest that this change may enable clinicians to maintain exceptional quality of care—both in terms of patient satisfaction and clinical outcomes—while simultaneously lowering the risk of nosocomial infections, and reducing resource utilization,” the authors concluded.

Read the full analysis here.