Three Days in Hospital Enough for Some Heart Attack Patients?
March 15, 2000 (Washington) -- Many people who have a heart attack can
safely return home after just three days in the hospital, as long as they don't
have other serious problems, according to a study in the March 16 issue of
TheNew England Journal of Medicine. Serious problems that could
preclude such a short stay range from having a stroke or second heart attack to
abnormal heart beats.
But hospitals and physicians first must make sure that everything was done
right in the hospital and that the patient and his or her family are
sufficiently prepared to cope once they leave, the lead author tells WebMD.
"We are not endorsing or saying in this study that we think patients
should go home after three days," says L. Kristin Newby, MD. "What we
are saying is, here is an opportunity. Almost 60% of heart attacks are
uncomplicated. [But] most hospitals and physicians can't provide all the
high-quality, evidence-based care in that shortened time frame. While it does
look like an exciting opportunity, we are probably not there yet in terms of
delivery." Newby is an assistant professor in the division of cardiology at
Duke University School of Medicine in Durham, N.C.
"I don't think this is dramatic news and I don't think there will be
much of a fight over this, " says cardiologist Allen J. Solomon, MD, an
associate professor of medicine at Georgetown University in Washington. "It
doesn't necessarily apply to all other patients. Now, if the evening news says
you only need to stay three days for a heart attack, and it is not presented as
[being] appropriate for a subset of patients who are doing extraordinarily
well, then there could be a fight." Solomon reviewed the study for
The findings are based on a study of more than 22,300 patients who were
enrolled in another study that was trying to determine the effectiveness of
clot-busting medications. None of the patients in that study had complications
for 72 hours after being given the medication. Complications that can occur
include a second heart attack, stroke, congestive heart failure, irregular
heartbeats, and the need for emergency surgery to unclog arteries. Sixteen
patients of the more than 22,300 had irregular heartbeats during the next
24-hour period. Three of them died.
Applying these findings to clinical practice will take some work, Newby
admits. "We need to ensure that everybody goes home on aspirin, gets their
[cholesterol] medications. ... That is going to take a certain amount of
knowledge and testing, and coordination and communication between the inpatient
and outpatient [settings] to make sure medications that are started in the
hospital are continued at the right doses."
In addition, the patient and his or her family need to be psychologically
prepared to cope with the impact of a heart attack, which for many people is a
life-altering event. "The patient is the main reason we are doing this, and
we need to make sure there aren't any issues regarding the patient that need to
be factored into the equation," Newby says.