Early discharge after acute myocardial infarction - is it safe?

Since the 1950s, usual hospital stays following uncomplicated myocardial infarctions have been reduced, on the basis of study evidence, from 4-8 weeks to 7-10 days. New techniques including reperfusion have been developed for the care of patients after infarction and have prompted a study [see Cost Benefit section, this issue, p5] which examined the effects of a 3-day versus a 7-to 10-day hospital stay. The patients included in the study were carefully chosen following exercise testing and represented only 18% of the total population with infarction. Only approximately one quarter of the study population had had an anterior infarction and nearly all had received reperfusion therapy. This study group was too small to statistically determine the frequency of complications which occurred at home in the early discharge group. It did demonstrate, however, that even rigorous screening could not determine all at-risk patients; 3/80 patients experienced reinfarctlon within the first week of the study.

The results of this study should be extrapolated to the general population with caution. Patients whose Infarctions are classified as uncomplicated can be recommended for early discharge ~ 5 days postinfarction, but extensive follow-up should be available to them. However, until the safety of early discharge has been demonstrated in suitably selected patients ' ... we should proceed with caution in formulating new guidelines for a shorter hospital stay, lest we commit the unfortunate mistake of sacrificing quality of care for the sake of cost control'. Curfman GO Ne'h England Journal of Medicine 318 1123-1124. 28 Apr 1988 6'38

0156-2703/88/0514-0003/0$01.00/0 © ADIS Press INPHARMA' 14 May 1988 3