Unnecessary hospital stay after heart attack common in European countries

A study investigating inconsistencies in the time patients spend in hospital after heart attack is detailed in this week's issue of The Lancet. Despite a decade of research suggesting that low-risk patients can be discharged from hospital after four days, many countries-especially in Europe-could be keeping patients in hospital for an unnecessary length of time.

Previous research has outlined how early discharge of low-risk patients with heart attack (acute myocardial infarction) is feasible after four days hospital stay, and can be achieved at no additional risk of adverse events. Padma Kaul from Alberta University, Canada, and colleagues from the Virtual Coordinating Center for Global Collaborative Cardiovascular Research (VIGOUR) assessed the extent to which different countries have taken advantage of the opportunity for early discharge.

The investigators analysed the hospital discharge data of over 50,000 people who took part in previous randomised trials (GUSTO-I, GUSTO-III, and ASSENT-2) covering the years 1990-98; these studies enrolled patients with heart attack in the USA, Canada, Australia, New Zealand, Belgium, France, Germany, Spain, and Poland.

The rate of early discharge of eligible patients was consistently low (less than 2%) in Belgium, France, Germany, Spain, and Poland, although the number of eligible patients discharged on or before day 4 increased in the USA, Canada, Australia, and New Zealand. Despite this increase, no more than 40% of patients who were eligible for early discharge were actually discharged early. In the most recent trial (ASSENT-2) the number of potentially unnecessary hospital days (per 100 patients enrolled) ranged from 65 in New Zealand to 839 in Germany.

Padma Kaul comments: "Despite more than a decade of research, there is still a lot of variation between countries in international length-of-stay patterns in acute myocardial infarction. The potential for more efficient discharge of

Contact: Joe Santangelo

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