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Risk score may allow for discharge of STEMI patients

Saturday November 3, 2012
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A simple-to-use risk score can identify low-risk patients following a ST-elevation myocardial infarction and may provide an opportunity to employ early discharge strategies to reduce length of hospital stay and save hospital costs without compromising the safety of the patient, according to a study.

Recently, there has been an emphasis on lowering both hospital length of stay and hospital readmission in patients with STEMI to decrease costs to the overall healthcare system, according to the study, which was presented by the Minneapolis Heart Institute Foundation on Oct. 23 at the 2012 Transcatheter Cardiovascular Therapeutics conference. STEMI patients in the U.S. have lower length of stay in the hospital but increased rates of hospital readmissions compared with other countries.

The Zwolle PCI Risk Index Scoring System is validated to identify low-risk STEMI patients for early discharge. "This is a simple-to-calculate risk score, which takes into account age, three-vessel disease, Killip Class, anterior infarction and TIMI flow post," Timothy D. Henry, MD, the studyís senior author and an interventional cardiologist at the Minneapolis Heart Institute at Abbott Northwestern Hospital, said in a news release.

"These risk factors can be easily and quickly assessed by healthcare professionals within a hospital."

For the study, Craig E. Strauss, MD, MPH, a cardiologist at MHI, and colleagues retrospectively applied the Zwolle Risk Score to all STEMI patients presenting to their large, regional STEMI system between January 2009 and December 2011.

Among the 967 cases, 44% were classified as high risk and 56% as low risk using the evaluation system. High-risk patients were older, had more hypertension, diabetes and previous coronary artery disease, were more likely to have had previous revascularization and had lower left ventricular ejection fractions.

The low-risk patients had significantly lower mortality rates than the high-risk patients in the in-hospital setting (0% vs. 11.9%), at 30 days (0.2% vs. 12.9%) and at one year (3.9% vs. 16.4%). Likewise, the low-risk patients had fewer complication rates across the board: any complication (6.5% vs. 17.1%), heart failure (0.3% vs. 2.1%), cardiogenic shock (0.3% vs. 5.1%) or new dialysis (0% vs. 1.7%).

"Because there is increasing pressure to reduce rising hospital costs while also reducing readmissions, this studyís findings are particularly important," Henry said. "We found that identifying low-risk patients in an easy, inexpensive manner can lead to safe discharge a full day in advance of high-risk STEMI patients."

The discharge of one day in advance for these low-risk patients led to a savings of nearly $7,000 in total hospital costs.

"Prospective use of this risk score may provide an opportunity to safely employ early discharge strategies to reduce length of stay and total hospital costs without compromising patient safety," the authors concluded.

Henry said as part of MHIís overall quality improvement program, cardiac patients identified as low-risk using the evaluation system will avoid the CICU and have a plan to be discharged in 48 hours. "This change in patient management is the result of the safety findings with this low-risk patient population in the study," Henry said.


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