Author + information
- Received November 5, 2018
- Revision received March 22, 2019
- Accepted March 26, 2019
- Published online August 5, 2019.
- Paraskevi Taxiarchi, MSca,
- Evangelos Kontopantelis, PhDb,
- Glen P. Martin, PhDa,
- Tim Kinnaird, MDc,d,
- Nick Curzen, PhDe,
- Adrian P. Banning, MDf,
- Peter Ludman, MDg,
- Mark De Belder, MDh,
- Muhammad Rashid, MBBSd,
- Matthew Sperrin, PhDa and
- Mamas A. Mamas, DPhilb,d,∗ ()
- aHealth eResearch Centre, Farr Institute, University of Manchester, Manchester, United Kingdom
- bDivision of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
- cDepartment of Cardiology, University Hospital of Wales, Cardiff, United Kingdom
- dKeele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, University of Keele and Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, United Kingdom
- eCoronary Research Group, University Hospital Southampton and Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- fDepartment of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
- gCardiology Department, Queen Elizabeth Hospital, Birmingham, United Kingdom
- hDepartment of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom
- ↵∗Address for correspondence:
Prof. Mamas A. Mamas, Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom.
Objectives The aim of this study was to evaluate national temporal trends in same-day discharge (SDD) and compare clinical outcomes with those among patients admitted for overnight stay undergoing elective percutaneous coronary intervention (PCI) for stable angina.
Background Overnight observation has been the standard of care following PCI, with no previous national analyses around changes in practice or clinical outcomes from health care systems in which SDD is the predominant practice for elective PCI.
Methods Data from 169,623 patients undergoing elective PCI between 2007 and 2014 were obtained from the British Cardiovascular Intervention Society registry. Multiple logistic regressions and the British Cardiovascular Intervention Society risk model were used to study the association between SDD and 30-day mortality.
Results The rate of SDD increased from 23.5% in 2007 to 57.2% in 2014, with center SDD median prevalence varying from 17% (interquartile range: 6% to 39%) in 2007 to 66% (interquartile range: 45% to 77%) in 2014. The largest independent association with SDD was observed for radial access (odds ratio: 1.69; 95% confidence interval: 1.65 to 1.74; p < 0.001). An increase in 30-day mortality rate 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 overnight stay (odds ratio: 1.15; 95% confidence interval: 0.294 to 4.475; p = 0.884).
Conclusions SDD has become the predominant model of care among elective PCI cases in the United Kingdom, 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 toward SDD practice have important economic implications for health care systems worldwide.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 5, 2018.
- Revision received March 22, 2019.
- Accepted March 26, 2019.
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