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Lengths of stay of patients with uncomplicated acute myocardial infarction at three Boston hospitals

Impact of pre-discharge tactics

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Abstract

Variability in length of stay (LOS) and its determinants were studied in 60 patients without complications after acute myocardial infarction (AMI) at three teaching hospitals. The patients at the three hospitals had similar clinical presentations and in-hospital courses. However, 81% of patients admitted to the intensive care unit (ICU) at one hospital were transferred to lower levels of care within 48 hours, compared with 40% and 56% at the other two hospitals (p<0.05). Patients who underwent pre-discharge exercise tests (ETT) had a longer total LOS than patients who did not (11.9±4.3 vs 9.2±2.9 days; p<0.01). Similarly, patients who underwent 24-hour ambulatory monitoring (AMB-MON) had a longer total LOS than patlents who did not (12.3±4.3 vs 9.1±2.8 days; p<0.001). No differences in clinical characteristics or in survival at six months were detected between patients who did and did not undergo ETT or AMB-MON. Total LOS correlated with whether patients underwent 0, 1, or both of these tests (p<0.001); each test was associated with a 2.3-day increase in the duration of hospitalization. The authors conclude that such tests may prolong total LOS of patients without complications after AMI.

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Authors and Affiliations

  1. Division of Clinical Epidemilogy, Brigham and Women’s Hospital, 75 Francis Street, 02115, Boston, MA

    Thomas H. Lee MD

Authors
  1. Thomas H. Lee MD
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  2. Lawrence K. Gottlieb MD, MPP
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  3. Leslie J. Weitzman MSM
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  4. Albert G. Mulley MD
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  5. Stephen G. Pauker MD
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  6. Barbara J. McNeil MD, PhD
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Additional information

Received from the Center for Cost-Effective Care and the Department of Medicine at the Brigham and Women’s Hospital and the Department of Medicine at the Massachusetts General Hospital, Harvard Medical School; and the Division of Clinical Decision Making, Department of Medicine, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts.

Supported by grants from the Hartford Foundation to the Brigham and Women’s Hospital and the New England Medical Center and from the Blue Cross/Massachusetts Hospital Fund for Cooperative Innovation to all three hospitals. Dr. Lee is the recipient of a Public Health Service Clinical Investigator Award (HL0 1594-01) from the National Heart, Lung, and Blood Institute. Dr. Mulley is a Henry J. Kaiser Family Foundation Faculty Scholar in General Internal Medicine.

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Lee, T.H., Gottlieb, L.K., Weitzman, L.J. et al. Lengths of stay of patients with uncomplicated acute myocardial infarction at three Boston hospitals. J Gen Intern Med 3, 239–244 (1988). https://doi.org/10.1007/BF02596338

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