Abstract:
Purpose:
Substantial heterogeneity in hospital length of stay exists among patients admitted with non-ST-segment elevation myocardial infarction. Furthermore,little is known about the factors that impact length of stay.
Methods:
We examined 39,107 non-ST-segment elevation myocardial infarction patients admitted to 351 Acute Coronary Treatment Intervention Outcomes Network Registry-Get With The Guidelines hospitals from January 1,2007-March 31,2009 who underwent cardiac catheterization and survived to discharge. Length of stay was categorized into 4 groups (≤2,3-4,5-7,and ≥8 days),where prolonged length of stay was defined as >4 days.
Results:
The overall median (25th,75th) length of stay was 3 (2,5) days. Patients with a length of stay of >2 days were older with more comorbidities,but were less likely to receive evidence-based therapies or percutaneous coronary intervention. Among the factors associated with prolonged length of stay >4 days were delay to cardiac catheterization >48 hours,heart failure or shock on admission,female sex,insurance type,and admission to the hospital on a Friday afternoon or evening. Hospital characteristics such as academic versus nonacademic or urban versus rural setting,were not associated with prolonged length of stay.
Conclusion:
Patients with longer length of stay have more comorbidities and in-hospital complications,yet paradoxically,are less often treated with evidence-based medications and are less likely to receive percutaneous coronary intervention. Hospital admission on a Friday afternoon or evening and delays to catheterization appear to significantly impact length of stay. A better understanding of factors associated with length of stay in patients with non-ST-segment elevation myocardial infarction is needed to promote safe and early discharge in an era of increasingly restrictive health care resources.
The American Journal of Medicine
