Three Days in Hospital Enough for Some Heart Attack Patients?
WebMD News Archive
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