Three Days in Hospital Enough for Some Heart Attack Patients?
An accompanying editorial, co-written by Elliot Antman, MD, an associate
professor of medicine at Harvard University School of Medicine, warns that the
findings "must not be used by insurance companies as the rationale for
refusing to pay for hospital stays beyond 72 hours for patients with
uncomplicated [heart attacks]." Instead, the study should instead serve as
"the impetus for further research," which should center on developing
better ways to determine which patients might develop complications following a
heart attack, according to the editorial.
Antman and his co-author also note that discussions of shortened stays,
specifically for mastectomies and births, were met with a huge public backlash
and ultimately legislation that mandated certain inpatient lengths of stay.
The primary value of the study is that it provides cost estimates for
hospital stays over three days. "I think it is reasonable and not
surprising," says Solomon. "I think [a three-day stay] is the standard
of care in some places and is becoming more of a national trend."
"We used to keep patients a few months, then a few weeks, now a few
days. We see lots of patients come in the throes of an acute [heart attack],
they have angioplasty, which immediately resolves the clot and their
symptoms," he says. "By the time they reach the hospital bed two hours
later, they are already doing well and saying, 'When can I go home?' I say,
'You can't go home; you just had a heart attack three hours ago!' Patients are
anxious to go home. Doctors are anxious to let them go home."
Solomon says that there are a small number of patients, perhaps 2% of those
who have a heart attack, who could go home after just two days. "You see a
guy sitting on his bed banging away on his laptop. ... If you've ever been in a
hospital, you don't have to be a doctor to know who looks like they are doing
- Nearly 60% of heart attack patients have no other serious complications,
and a new study shows that these patients may be able to leave the hospital
after just three days, instead of the usual five.
- One catch, according to a researcher, is that the hospital has to have all
the resources to provide high-quality care within such a short time period, and
most of them don't yet.
- Before leaving the hospital, patients need to be taking aspirin and
cholesterol-lowering medications, and patients and family members need to be
psychologically prepared to cope with the impact of a heart attack.