Key result
Early discharge (≤3 days) following acute coronary syndrome increased over 10 years and was associated with no increase in 1-year all-cause mortality (OR 0.991; 95% CI 0.979-1.003).
Why the study?
International guidelines recommend early discharge within 3 days for uncomplicated ACS, but contemporary literature regarding the safety of this strategy is limited.
Does early discharge (≤3 days) following acute coronary syndrome hospitalisation safely maintain clinical outcomes compared to longer lengths of stay?
Observational (n=130,037)
Yes
Does early discharge (≤3 days) following acute coronary syndrome hospitalisation safely maintain clinical outcomes compared to longer lengths of stay?
Odds Ratio: 0.991 (95% CI 0.979–1.003)
An increasing trend of early discharge (≤3 days) post-ACS is safe, with no increase in all-cause mortality and a reduction in net adverse clinical events up to 1 year, supporting current guideline recommendations.
Early discharge after ACS was associated with stable mortality; leaves open whether RCTs would confirm safety in unselected patients.
BACKGROUND: International guidelines recommend early discharge for uncomplicated acute coronary syndrome (ACS) patients within 3 days; however, there is a paucity of contemporary literature regarding the safety of this strategy. AIMS: To report the trends in the proportion of ACS hospitalisations discharged within 3 days and their outcomes in New Zealand. METHODS: ACS hospitalisations 2006-2015 using national routinely collected data were categorised by length of stay (LOS) into ≤3, 4-5 and >5 days, excluding deaths during the index admission. Trend analysis of death, cardiovascular and bleeding events and their composites (net adverse clinical events) at 30-day and 1-year post-discharge were performed using generalised linear mixed regression models adjusting for covariates by LOS subgroups. RESULTS: Among 130 037 ACS hospitalisations, LOS ≤ 3 days increased from 32% in 2006 to 44% in 2016. This trend was observed for all demographics, ACS subtypes and management strategies. Event rates at 30 days and 1 year were the lowest for the LOS ≤3 days subgroup (all-cause mortality 1.6% and 9.1% respectively). Thirty-day and 1-year all-cause mortality rates were unchanged over time for this subgroup (adjusted odds ratio (95% confidence interval) of 1.011 (0.985-1.038) and 0.991 (0.979-1.003)), while net adverse clinical event rates significantly decreased (0.962 (0.950-0.973) and 0.972 (0.964-0.980) respectively). CONCLUSION: There was a substantial increase in early discharge post-ACS over 10 years. These patients were associated with reduction in adverse clinical events up to 1 year and no increase in all-cause mortality. These findings from a comprehensive national register suggest that guideline recommendations on early discharge after uncomplicated ACS are safe and appropriate.
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Grey et al. (2020) conducted an observational in Acute coronary syndrome (n=130,037). Early discharge (length of stay ≤3 days) vs. Later discharge (4-5 days and >5 days) and temporal trends was evaluated on 1-year all-cause mortality trend (OR 0.991, 95% CI 0.979-1.003). Early discharge (≤3 days) following acute coronary syndrome increased over 10 years and was associated with no increase in 1-year all-cause mortality (OR 0.991; 95% CI 0.979-1.003).
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