Rashid, M, Taxiarchi, P, Kontopantelis, E, Martin, G, Kinnaird, T, Curzen, N, Banning, A, Ludman, P, De Belder, M, Sperrin, M and Mamas, M ORCID: https://orcid.org/0000-0001-9241-8890 (2019) Same day discharge after elective percutaneous coronary intervention: insights from the British Cardiovascular Intervention Society. JACC: Cardiovascular Interventions, 12 (15). pp. 1479-1494.

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Abstract

Objectives
We aimed to evaluate national temporal trends of same day discharge (SDD) and compare clinical outcomes to patients admitted for overnight stay (ON) undergoing elective PCI for stable angina.

Background
ON observation has been the standard of care following PCI, with no previous national analyses around changes in practice or clinical outcomes from healthcare systems in which SDD is the predominant practice for elective PCI.

Methods
Data from 169,623 patients undergoing elective PCI between 2007-2014 were obtained from the British Cardiovascular Intervention Society registry. Multiple logistic regressions and the BCIS risk model were used to study association between SDD and 30-day mortality.

Results
SDD rates increased from 23.5% in 2007 to 57.2% in 2014, with centre SDD median prevalence varying from 17% (IQR 6% –39%) in 2007 to 66% (IQR 45% –77%) in 2014. The largest independent association with SDD was observed for radial access, OR=1.69 (95% CI 1.65 to 1.74, P<0.001). An increase in 30-day mortality rates 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 ON (OR=1.15, 95% CI 0.294 to 4.475, P=0.884).

Conclusions
SDD has become the predominant model of care amongst elective PCI cases in the UK, 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 towards SDD practice have important health economic implications for healthcare systems worldwide.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Elsevier at http://doi.org/10.1016/j.jcin.2019.03.030 - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: Elective Percutaneous coronary intervention, Same day discharge, Mortality, Outcomes
Subjects: R Medicine > R Medicine (General)
R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Depositing User: Symplectic
Date Deposited: 27 Mar 2019 08:44
Last Modified: 05 Aug 2020 01:30
URI: https://eprints.keele.ac.uk/id/eprint/6111

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