Reports From The Field-Cardiology

arly discharge after MI appears safe

Extending hospital stays for uncomplicated acute myocardial infarction (MI) beyond three days appears to be unnecessary and economically undesirable, according to a recent study reported in The New England Journal of Medicine.

Researchers used data from the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO-1) trial to identify 22,361 patients with acute MI who had an uncomplicated course for 72 hours after thrombolysis.

Then, using a decision-analytic model, they examined the cost-effectiveness of an additional day of hospitalization in this group. Researchers defined incremental survival attributable to another day of monitored hospitalization, on the basis of rate of resuscitation after cardiac arrest between 72 hours and 96 hours. Lifetime survival curves for each group in the decision model were estimated from one-year survival data from GUSTO-1.

Improving the bottom line

Researchers found that of the 22,361 patients with an uncomplicated course within 72 hours after thrombolysis, 16 had ventricular arrhythmias during the next 24 hours. Of those 16, 13, or 81%, survived at least 24 hours. On average, another 0.006 year of life per patient could be saved by keeping patients with an uncomplicated course in the hospital another day. At a cost of $624 for hospital and physicians' serv-ices, extending the hospital stay by another day would cost $105,629 per year of life saved. In sensitivity analyses, researchers found that a fourth day in the hospital would be economic-ally attractive only if its cost could be reduced by more than 50% or if a high-risk subgroup could be accurately identified in which the estimated survival benefit would be doubled.

[See: Newby LK, Eisenstein EL, Califf RM, et al. Cost effectiveness of early discharge after uncomplicated acute myocardial infarction. N Engl J Med 2000; 342:749-755.]