Same day discharge after elective percutaneous coronary intervention: insights from the British Cardiovascular Intervention Society

Taxiarchi, Paraskevi; Kontopantelis, Evangelos; Martin, Glen P.; Kinnaird, Tim; Curzen, Nick; Banning, Adrian P.; Ludman, Peter; De Belder, Mark; Rashid, Muhammad; Sperrin, Matthew; Mamas, Mamas A.

Abstract

Objectives
We aimed to evaluate national temporal trends of same day discharge (SDD) and compare clinical outcomes to patients admitted for overnight stay (ON) undergoing elective PCI for stable angina.

Background
ON observation has been the standard of care following PCI, with no previous national analyses around changes in practice or clinical outcomes from healthcare systems in which SDD is the predominant practice for elective PCI.

Methods
Data from 169,623 patients undergoing elective PCI between 2007-2014 were obtained from the British Cardiovascular Intervention Society registry. Multiple logistic regressions and the BCIS risk model were used to study association between SDD and 30-day mortality.

Results
SDD rates increased from 23.5% in 2007 to 57.2% in 2014, with centre SDD median prevalence varying from 17% (IQR 6% –39%) in 2007 to 66% (IQR 45% –77%) in 2014. The largest independent association with SDD was observed for radial access, OR=1.69 (95% CI 1.65 to 1.74, P<0.001). An increase in 30-day mortality rates over time for the SDD cases was observed, without exceeding the predicted mortality risk. According to the difference-in-differences analysis, observed 30-day mortality temporal changes did not differ between SDD and ON (OR=1.15, 95% CI 0.294 to 4.475, P=0.884).

Conclusions
SDD has become the predominant model of care amongst elective PCI cases in the UK, in increasingly complex patients. SDD appears to be safe with 30-day mortality rates in line with those calculated using the national risk prediction score used for public reporting. Changes towards SDD practice have important health economic implications for healthcare systems worldwide.

Citation

Taxiarchi, P., Kontopantelis, E., Martin, G. P., Kinnaird, T., Curzen, N., Banning, A. P., Ludman, P., De Belder, M., Rashid, M., Sperrin, M., & Mamas, M. A. (2019). Same day discharge after elective percutaneous coronary intervention: insights from the British Cardiovascular Intervention Society. JACC. Cardiovascular interventions, 1479-1494. https://doi.org/10.1016/j.jcin.2019.03.030

• Acceptance Date: Mar 26, 2019
• Publication Date: Aug 12, 2019
• Journal: JACC: Cardiovascular Interventions
• Print ISSN: 1876-7605
• Pages: 1479-1494
• DOI: https://doi.org/10.1016/j.jcin.2019.03.030
• Keywords: Elective Percutaneous coronary intervention, Same day discharge, Mortality, Outcomes; access approach, chronic total occlusion, elective, mortality, percutaneous coronary intervention, same-day discharge, transradial access
• Public URL: https://keele-repository.worktribe.com/output/413178
• Publisher URL: http://doi.org/10.1016/j.jcin.2019.03.030