Identifying patients for safe early hospital discharge following st elevation myocardial infarction

Abstract

Low risk patients identified using CADILLAC risk score with STEMI treated successfully with primary PCI have a low adverse event rate on the third day or later of hospitalization suggesting that an earlier discharge is safe in properly selected patients. Monitoring in a noncritical care setting following primary PCI for STEMI may be feasible for selected patients. © 2016 Wiley Periodicals, Inc.

Value-Based ST-Segment–Elevation Myocardial Infarction Care Using Risk-Guided Triage and Early Discharge

“…While this current initiative focuses on post-PCI care for STEMI, numerous other risk calculators and models exist across the spectrum of cardiovascular disease. 13–15 Within acute myocardial infarction, expansion of risk models to the triage of patients presenting with non-ST Elevation Myocardial Infarction and Unstable Angina for early discharge may be able to realize similar reductions in LOS and total costs, without compromising quality of care or patient outcomes. Similarly, as percutaneous approaches to structural and valvular heart disease increase, risk-based care delivery strategies may help to achieve higher value care.…”

“…We also employed just one risk score (Zwolle), while others, such as the CADILLAC Score, have also been described for the purpose of identifying patients for early discharge. 13 The prior validation of the Zwolle Risk Score and the ubiquitous nature of the EMR across the health system, however, provide the framework for this model to be adopted in other institutions. Our institution also integrates quality metrics into providers’ salary, which likely contributed to the rapid early uptake of the protocol, which may not occur at institutions without similar mechanisms in place.…”

Safety of early discharge after primary angioplasty in low-risk patients with ST-segment elevation myocardial infarction: A meta-analysis of randomised controlled trials

“…Candidates for early discharge after STEMI can be identified using simple criteria, such as the Zwolle risk score (ZRS), PAMI-II criteria, CADILLAC risk or other criteria. 10,19,20 The ZRS was described by De Luca et al in 2004; 20 it has been proved to be a useful index for risk stratification after primary PCI. The risk score is a simple six-item score, including age 60 years or older, time to reperfusion more than 4 hours, anterior infarct, TIMI flow post-angioplasty, three-vessel disease and Killip class.…”

Length of stay following percutaneous coronary intervention: An expert consensus document update from the society for cardiovascular angiography and interventions

“…Several observational and a few randomized studies have studied which patients might be candidates for early discharge after PPCI (Figure ). In one study of 228 patients, patients with a low CADILLAC score, a validated STEMI risk assessment tool, had a lower rate of MACE beyond 3 days after PPCI compared to those with an intermediate or high score (0% vs 11.4%, P = .0002) . In another study of 845 STEMI patients, the addition of N‐terminal pro‐brain natriuretic peptide (NT‐pro‐BNP) levels improved the prognostic value of the Zwolle risk score (ZRS) in predicting 30‐day mortality.…”