Step-down units are cost-effective alternatives to coronary care units with non-inferior outcomes in the management of ST-elevation myocardial infarction patients ... View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2019-01-31

AUTHORS

Yu-Shao Chou, Hsin-Yueh Lin, Yi-Ming Weng, Zhong Ning Leonard Goh, Cheng-Yu Chien, Hsuan-Jui Fan, Chih-Huang Li, Hsien-Yi Chen, Ming-Shun Hsieh, Joanna Chen-Yeen Seak, Chen-Ken Seak, Chen-June Seak

ABSTRACT

Percutaneous coronary interventions (PCIs) within a door-to-balloon timing of 90 min have greatly decreased mortality and morbidity of ST-elevation myocardial infarction (STEMI) patients. Post-PCI, they are routinely transferred into the coronary care unit (CCU) regardless of the severity of their condition, resulting in frequent CCU overcrowding. This study assesses the feasibility of step-down units (SDUs) as an alternative to CCUs in the management of STEMI patients after successful PCI, to alleviate CCU overcrowding. Criteria of assessment include in-hospital complications, length of stay, cost-effectiveness, and patient outcomes up to a year after discharge from hospital. A retrospective case-control study was done using data of 294 adult STEMI patients admitted to the emergency departments of two training and research hospitals and successfully underwent primary PCI from 1 January 2014 to 31 December 2015. Patients were followed up for a year post-discharge. Student t test and χ2 test were done as univariate analysis to check for statistical significance of p < 0.05. Further regression analysis was done with respect to primary outcomes to adjust for major confounders. Patients managed in the SDU incurred significantly lower inpatient costs (p = 0.0003). No significant differences were found between the CCU and SDU patients in terms of patient characteristics, PCI characteristics, in-hospital complications, length of stay, and patient outcomes up to a year after discharge. The SDU is a viable cost-effective option for managing STEMI patients after successful primary PCI to avoid CCU overcrowding, with non-inferior patient outcomes as compared to the CCU. More... »

PAGES

1-8

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s11739-019-02037-z

DOI

http://dx.doi.org/10.1007/s11739-019-02037-z

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1111830398

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/30706252


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