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Discharge Time After Angioplasty Varies

Experts offer guidelines to help determine which patients need more observation

THURSDAY, May 7 (HealthDay News) -- While some heart patients can safely go home after having elective angioplasty (also known as percutaneous coronary intervention, or PCI), others may have to stay in hospital for longer periods of time, says an expert consensus statement released Thursday.

The statement, published by the Society for Cardiovascular Angiography and Interventions (SCAI), notes that changes in reimbursement have put pressure on U.S. hospitals to make elective PCI a same-day outpatient procedure. But this could put patients at risk if they're sent home prematurely, and doctors don't have clear guidance regarding these patients, according to the SCAI.

Elective PCI is performed on patients who have stable heart symptoms but who have had testing abnormalities indicating the need for further evaluation.

"Because of continued breakthroughs in interventional cardiology, few patients today have to stay in the hospital for two or more days after angioplasty as they did in the past, but it's not always clear which patients should be kept overnight or admitted to the hospital, and which patients can safely return home the same day," statement senior author Dr. Carl Tommaso, an associate professor of medicine at Rush University Medical School, and director of the cardiac catheterization lab at Skokie Hospital, North Shore University Health Systems in Chicago, said in a SCAI news release.

"The goal of this document is to guide physicians making decisions for follow-up care after an elective PCI. Ultimately, the physician should make the decision based on the patient's specific condition and the criteria outlined in this paper," Tommaso said.

The consensus statement concludes that some patients can be discharged the day of their PCI. Others, however, should be observed or admitted, as determined by the treating physician, in one of the following three settings:

  • Observation. This is for patients who require a period of observation that does not exceed 24 hours, such as an overnight stay to monitor for potential complications or to conduct lab tests. This category is also appropriate for patients who lack adequate at-home care or access to emergency medical services.
  • Extended observation. Patients in this category require more than 24 hours of observation and care, often due to accompanying non-cardiac conditions.
  • In-patient admission. This category includes patients who experienced complications during PCI, those who require further revascularization, and those with significant accompanying health problems.

The consensus statement appears online and in the June print issue of the journal Catheterization and Cardiovascular Interventions.

More information

The U.S. National Heart, Lung, and Blood Institute has more about angioplasty.

-- Robert Preidt

SOURCE: Society for Cardiovascular Angiography and Interventions, news release, May 7, 2009

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