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Same-day discharge after angioplasty seems safe

By Andrew M. Seaman

NEW YORK (Reuters Health) - After angioplasty to improve blood flow to the heart, some patients may be able to go home from the hospital the same day without raising their risk of complications, according to a new review.

Based on data from 37 previous studies, researchers found no differences in the number of deaths, heart attacks, serious bleeding or other complications among otherwise healthy people discharged the same day as their angioplasty procedure and those observed overnight at the hospital.

"In carefully selected patients there is no increased risk of sending patients home the same day as watching them overnight," said Dr. Kimberly Brayton, the study's lead author, from the Stanford School of Medicine in California.

During coronary angioplasty, also known as percutaneous coronary intervention (PCI), a balloon-tipped catheter is threaded through blood vessels in the wrist or thigh toward the heart. The balloon is inflated to clear one or more narrowed vessels, then, in most cases, a small mesh tube known as a stent is used to prop each vessel open.

About 500,000 angioplasties are performed in the U.S. every year - roughly half of them are non-emergency procedures, scheduled after medical testing has revealed narrowed vessels restricting blood flow to the heart.

In most cases, patients undergoing angioplasty are kept in the hospital at least overnight to watch for signs of complications, according to the report by Brayton's team published in the Journal of the American College of Cardiology.

But complications are rare, especially among people with no other serious health issues. When complications of angioplasty do occur, they usually happen in the six hours following the procedure - which suggests low-risk patients undergoing elective PCIs may be able to safely go home on the same day.

While sending patients home a little bit earlier would not save the health system money in the near future, researchers said, it could free up beds in hospitals and let patients recover in familiar surroundings.

"They probably are better off at home with their family, their own bed and bathroom," said Dr. Karen Joynt, who has studied angioplasty outcomes at the Harvard School of Public Health in Boston but wasn't involved in the new study.

Previous research looking at this question consisted of small studies from individual hospitals. Brayton and her colleagues pulled many of those together to see how a larger number of people fared overall.

Of 12,803 angioplasty patients included in the review, most had the procedure to treat stable angina, which is chest pain that's caused by poor blood flow to the heart during physical activity.

The researchers found no difference in the number of complications among patients who were sent home on the same day as their surgery, and those who were kept overnight in the hospital.

Regardless of which group they were in, about 1 percent of patients died, had a heart attack or needed a second angioplasty between one and 30 days after the first procedure. Major bleeding and other problems occurred in about 0.68 percent of the patients.

The results are limited by the fact that patients in many of the smaller trials included in the review had to be willing to go home the day of their procedure, so the findings could be biased.

Patients with chronic kidney disease and those with a particular heart weakness known as low left ventricular ejection fraction, were excluded from most of the studies because they are more prone to complications.

Brayton's team devised a checklist that would indicate generally healthy patients who are candidates to be sent home the same day. The list includes being younger than 75, having no acute coronary syndrome or allergy to contrast agents used in the procedure and living 30 to 60 minutes from the hospital as well as having adequate social support.

Brayton said the results suggest that carefully selected patients should be able to go home the same day as their procedure as long as they can come back to the hospital if there are any problems.

"Assuming the patients are chosen carefully, I think it makes a lot of sense," Joynt told Reuters Health.

SOURCE: http://bit.ly/11AIhhY Journal of the American College of Cardiology, online April 23, 2013.

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