Three Days in Hospital Enough for Some Heart Attack Patients?
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.
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 well."