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Three Days and Out for Uncomplicated MI

Despite increasing economic pressure on hospitals to reduce stay length, it often is difficult to assess how shortening stays affects patient outcomes. International investigators used data from the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO-1) trial to determine the cost-effectiveness of hospitalization beyond 72 hours for patients with suspected acute MI who had suffered no cardiac complications for 3 days after thrombolysis.

Of 38,911 patients with uncomplicated courses (defined as the absence of death, reinfarction, heart failure, recurrent ischemia, shock, stroke, emergency angiography or angioplasty, bypass surgery, intra-aortic balloon pumping, or cardioversion or defibrillation), only 16 developed ventricular arrhythmias on day 4; 13 of these 16 survived for at least another 24 hours. Using a decision-analytic model to calculate the cost-effectiveness of an additional day of hospitalization, the investigators estimated that 0.006 year of life would be gained at an incremental cost of $624; the resulting ratio was $105,629 per year of life saved. On the basis of the 95 percent confidence interval for the additional day, the cost-effectiveness ratio ranged from $65,777 to $183,525 per year of life saved.

Comment: The results of this study demonstrate that MI patients with an uncomplicated 3-day course after thrombolysis have extremely low risk for developing clinically noteworthy ventricular arrhythmias. By conventional standards, the high cost of an additional day of hospitalization seems unattractive. Although these researchers could not address whether any interventions performed on day 4 would have prevented the development of ventricular arrhythmias, they nevertheless present useful data about this difficult issue.

— HM Krumholz

Published in Journal Watch Cardiology May 5, 2000

Citation(s):

Newby LK et al. Cost effectiveness of early discharge after uncomplicated acute myocardial infarction. N Engl J Med 2000 Mar 16 342 749-755.

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