Spectrum Health Catheterization Lab Study Supports Same-Day Discharge

Guidelines can identify low-risk patients who do not require overnight stays

Spectrum Health researchers have found that by using careful guidelines, many patients undergoing angioplasty and stenting do not require overnight stays.

The findings were part of an original study titled “Assessment of Clinical Outcomes Related to Early Discharge after Elective Percutaneous Coronary Intervention.” It was published in the January 2013 issue of Catheterization and Cardiovascular Interventions.

“The basic findings in our study showed that if you carefully select and monitor your patients undergoing a coronary intervention, most of them will not require an overnight stay,” said study coauthor David Wohns, MD, medical director of the cath labs at Spectrum Health’s Fred and Lena Meijer Heart Center. “This is certainly appreciated by those patients and it’s more-cost effective.”

The study focused on 200 patients that underwent a non-emergency percutaneous coronary intervention (PCI) and were selected for same day-discharge (SDD). PCI is a procedure which most often involves a catheter being threaded through an artery into the heart. A balloon catheter is then used to open a narrowed artery and a wire meshed cylinder called a stent is placed to help keep the artery open.

A team from Spectrum Health selected the 200 low-risk patients. They were selected and monitored through the PCI and recovery period using guidelines developed at Spectrum Health. There also were guidelines established for discharging patients.

Preprocedure screening guidelines included meeting standards for heart function and medical history, blood chemistry, family support and distance from home to a hospital. Procedure guidelines included condition of the vessel treated, number of stents placed and length of procedure. Post-procedure guidelines included no complications at the entry site and stable heart rate and blood pressure. At discharge, no chest pain, stable vital signs, no nausea and ability to walk without complications were among the guidelines.

After discharge, patients were followed to see if they suffered any major adverse cardiac events (MACE) within one and seven days. MACE includes heart attacks, strokes, pulmonary embolisms and death. Issues such as bleeding at the entry site, readmissions and emergency department visits also were evaluated.

No major bleeding or MACE was reported within seven days. Within the seven days, eight patients experienced minor bleeding, four were readmitted and three had ED visits.

An overnight stay after PCI is the standard approach in the majority of hospitals in the U.S., said Wohns. “This study showed that our guidelines identify low-risk PCI patients who can be safely considered candidates for SDD with virtually no short-term adverse consequences. Studies such as this one are important because data supporting SDD, while maintaining patient safety, has not been well established.”

In addition to the study’s publication in Catheterization and Cardiovascular Interventions, it was the “Editors’ Pick” for the month. It also was cited in an editorial about the need for more study on this subject.

The authors of this study are:

Purushothaman Muthusamy MD, a medical resident at Spectrum Health, and part of the Department of Research, Grand Rapids Medical Education Partners.
Denise K. Busman MSN, RN, a cardiology clinical nurse specialist with Frederik Meijer Heart and Vascular Institute
Alan T. Davis PHD, of the Department of Research, Grand Rapids Medical Education Partners and Department of Surgery, Michigan State University College of Human Medicine.
David H. Wohns MD, FACC, FSCAI , medical director, Interventional Cardiology at Spectrum Health.

Spectrum Health is a not-for-profit health system in West Michigan offering a full continuum of care through the Spectrum Health Hospital Group, which is comprised of nine hospitals including Helen DeVos Children’s Hospital, a state of the art children’s hospital that opened in January 2011, and 140 service sites; the Spectrum Health Medical Group and West Michigan Heart, physician groups totaling more than 700 providers; and Priority Health, a health plan with 600,000 members. Spectrum Health is West Michigan’s largest employer with 19,000 employees. The organization provided $204 million in community benefit during its 2012 fiscal year.