Cost-Effectiveness of Early Discharge (<48 Hours) for Low-Risk Patients Following PPCI for STEMI

Abstract

Background: Early discharge after primary percutaneous coronary intervention can increase the efficiency of health care, enabling cost savings. Dedicated virtual follow-up pathways can provide remote diagnostic information to aid earlier discharge, optimize care and reduce unplanned readmissions.

Objectives: The aims of this study were: 1) to review the long-term (1-year) safety of early hospital discharge (<48 hours) after ST-segment elevation myocardial infarction; 2) to assess the effect of virtual follow-up on medication adherence and ability to up-titrate secondary prevention medication; and 3) to determine the cost-effectiveness of a virtual follow-up pathway after early discharge.

Methods: Between April 2020 and March 2023, 1,500 low-risk patients were discharged at <48 hours and placed on the early hospital discharge follow-up pathway. Patients were reviewed by structured virtual follow-up at 48 hours; 2, 4, and 8 weeks; and 3 and 12 months.

Results: The median length of hospital stay was 24.9 hours (Q1-Q3: 22.8-36.4 hours), with a minimum of 17 hours and a maximum of 40 hours. Seventy-three percent of patients (1,095 of 1,500) stayed 1 fewer night in the hospital compared with normal pathways. The median length of stay for the control group was 68.1 hours (Q1-Q3: 56-80 hours) (P < 0.0001). During 12-month follow-up, there was a low major adverse cardiac event rate of 3.1% (47 of 1,500) including 0.6% (9 of 1,500) for all-cause mortality and 0.13% (2 of 1,500) for cardiovascular mortality in the early hospital discharge group, which compared favorably with the >48-hour control group (major adverse cardiac event rate 5.5% [77 of 1,400]; P = 0.043).

Conclusions: Selected low-risk patients can be discharged securely and safely following successful primary percutaneous coronary intervention using a pathway that is reinforced by a formal, multidisciplinary virtual follow-up program, enabling improvements in medication adherence and up-titration.

Keywords: PCI; STEMI; early hospital discharge.