Patients with clogged arteries who get a heart stent implanted to hold open the vessels may safely be released from the hospital the same day as the procedure, potentially reducing health-care costs, a study found.
Those sent home the day they received a stent were just as healthy as patients hospitalized overnight for observation, according to research today in the Journal of the American Medical Association. No difference between the groups was seen in the rates of death and readmission to the hospital at two days or 30 days after the procedure, the study found.
Doctors are leery about sending patients home the same day as a stent procedure because complications may arise including heart attack, blood clots and bleeding, Sunil Rao, the lead study author, said. The number of complications are small and declining and, based on these results, doctors and hospitals may want to allow low-risk patients to go home the same day they receive the device, he said.
“As long as you select the patients very carefully, sending them home the same day seems to be safe or just as safe as observing them overnight,” said Rao, an associate professor of medicine at Duke University Medical Center in Durham, North Carolina, and director of the Cardiac Catheterization Lab at the Durham VA Medical Center, in a Sept. 30 telephone interview.
More same-day discharges would provide hospitals with more space for sicker patients needing overnight stays and reduce health-care costs, Rao and his colleagues wrote.
Stents are tiny mesh tubes used to prop open arteries after they’ve been cleared of fat clogging the flow of blood. The devices are inserted with a catheter in a patient’s groin and threaded through the circulatory system to the artery.
Abbott Laboratories, Boston Scientific Corp. and Medtronic Inc. are the leading U.S. makers of drug-coated heart stents in the $4 billion a year global market.
Among the considerations for doctors and hospitals before deciding whether a patient should be sent home or kept overnight are the results of the surgery, the patient’s support network at home and whether there is access to emergency care if necessary.
About 1.2 million inpatient stent procedures, called Percutaneous Coronary Intervention or PCI, were performed in 2007, according to a December study in Circulation, Journal of the American Heart Association. It is one of the most commonly performed heart procedures among Medicare patients, the authors said.
Researchers in the study looked at data from the American College of Cardiology on 107,018 patients ages 65 and older on Medicare who had elective coronary stent procedures from November 2004 to December 2008. Medicare is the U.S. health program for the elderly and disabled.
They found that only 1,339, or 1.25 percent, of patients were sent home the same day as their procedure.
No difference was seen between those sent home the same day and those observed overnight in the rates of general complications and bleeding issues, the study showed.
The study shows that what was once a three-day admission for patients can now be finished safely in a few hours, said William O’Neill, chief medical officer for the University of Miami Health System.
“Now that it appears to be safe in a large group of patients, there’s going to be a push to send people home the same day,” he said in a Sept. 30 telephone interview. “This is going to be more convenient for patients.”
Today’s study was funded by the American College of Cardiology.
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