April 28, 1988New England Journal of Medicine
A Randomized Controlled Trial of Hospital Discharge Three Days after Myocardial Infarction in the Era of Reperfusion
Why the study?
Does early hospital discharge on day 3 reduce hospital charges without increasing clinical complications in patients with uncomplicated myocardial infarction?
Population
80 patients with uncomplicated acute myocardial infarction. 76 of 80 received coronary reperfusion therapy.
Comparison
Early hospital discharge on day 3 vs Conventional hospital discharge on days 7 to 10
Design
RCT, randomly assigned
Follow-up
6 months
Authors
Discussion
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Member takes
Implication
Supports early discharge on day 3 after uncomplicated MI to lower costs; extends RCT evidence for safe post-MI protocols.
Key Points
- To assess the feasibility, safety, and economic impact of hospital discharge three days after acute myocardial infarction in selected low-risk patients who underwent reperfusion therapy.
- Among 507 consecutively screened patients with acute myocardial infarction, 80 uncomplicated patients without provocable ischemia on early exercise testing were randomized to early discharge (day 3) or conventional discharge (days 7 to 10).
- Reperfusion therapy (thrombolysis, angioplasty, or both) was administered to 76 of the 80 randomized patients, and all participants were followed prospectively for six months.
- At six months, zero deaths and zero new ventricular aneurysms occurred in either arm; the early versus conventional discharge groups had 6 versus 10 readmissions, 0 versus 5 reinfarctions, and 3 versus 8 patients with angina.
- Cumulative hospital and professional charges were significantly lower with early discharge ($12,546 ± $3,034) than with conventional discharge ($17,868 ± $3,688, P < 0.0001).
- Employed patients in the early-discharge group returned to work earlier (mean 40.7 ± 21.9 days) than those in the conventional-discharge group (mean 56.9 ± 30.3 days, P = 0.054).
Structured PICO
Does early hospital discharge on day 3 reduce hospital charges without increasing clinical complications in patients with uncomplicated myocardial infarction?
P
Population
80 patients with uncomplicated acute myocardial infarction (no angina, heart failure, or arrhythmia 72 hours after admission, and no provocable myocardial ischemia on early exercise testing). 76 of 80 received coronary reperfusion therapy.
I
Intervention
Early hospital discharge on day 3
C
Comparator
Conventional hospital discharge on days 7 to 10
O
Outcome
Feasibility, cost savings (hospital and professional charges), and clinical complications at 6 months
Early hospital discharge 3 days after an uncomplicated myocardial infarction is feasible and significantly reduces hospital charges without apparent increases in adverse clinical events.
Limitations
- small sample size requiring confirmation in larger prospective clinical trials
Cite This Study
Topol et al. (1988) studied this question.