Outcomes in patients with myocardial infarction who are initially admitted to stepdown units: data from the multicenter chest pain study

Article Abstract:

Patients with suspected heart attack (acute myocardial infarction) are usually admitted to intensive coronary care units, but less than half of these patients actually experience a heart attack. Efforts are underway to improve the methods of identifying patients with heart attacks, and thereby decrease the high costs of admission to coronary care units. Specifically, health care costs would be decreased if patients with chest pain, and with characteristics suggestive of a low risk of heart attack, were initially admitted to intermediate care, or 'stepdown' unit. Low-risk patients with suspected heart attack who receive treatment in stepdown units have not been previously studied. The outcome of 58 patients admitted to a stepdown unit with chest pain was compared with that of 409 patients admitted to a coronary care unit. A poor outcome, such as death or serious complications, occurred in 16 stepdown patients and in 159 coronary care unit patients. Statistical analysis of the results showed that the risk of a poor outcome was similar for patients admitted either to a stepdown unit or coronary care unit. The findings suggest that admission of patients with chest pain and a low probability of developing a heart attack to a stepdown unit does not increase the risk of a poor outcome, even for those patients who eventually are diagnosed with a heart attack. However, the risk for poor outcome in individuals with chest pain who are treated in stepdown units requires further investigation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Evaluation, Economic aspects, Heart attack, Hospitals, Cardiac patients, Intensive care units, Coronary care units, Hospital services, Cardiovascular services

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Preventability of emergent hospital readmission

Article Abstract:

Much focus had been placed recently on how to cut health care costs. Hospitals are being required to examine areas where resources are wasted. Readmission of patients that have been recently discharged represents an area of disproportionately high costs. Prevention of these readmissions could save large amounts of money. This study examined readmissions to a hospital within 30 days of discharge to determine which and how many could have been prevented. Records of all patients admitted during a four-month period were obtained, from which the records of those discharged and readmitted within 30 days were selected for the study. Their charts were reviewed to assess the preventability of the readmission. Results showed 2,626 admissions during the period with 327 (12 percent) readmissions. Patients readmitted were more likely to be older, male, and receiving Medicare or welfare. It was concluded that 28 (8.8 percent) of the readmissions probably could have been prevented. Nine of these were medication-related problems. These preventable readmissions represented 1 percent of all admissions for the period. Most preventable readmissions (25 of 28) occurred within 10 days of the original discharge. These results indicated that for this hospital, most readmissions were not preventable. In the small number that were, most occurred within 10 days of original discharge, indicating an early, postdischarge evaluation of all patients might be useful. (Consumer Summary produced by Reliance Medical Information, Inc.)

Statistics, Emergency medical services, Hospital patients, Hospital utilization

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Prediction of cardiac and pulmonary complications related to elective abdominal and noncardiac thoracic surgery in geriatric patients

Article Abstract:

Heart and lung complications resulting from abdominal and non-heart-related chest surgery are the most common causes of death and serious disease in elderly patients. The effectiveness of a bicycle exercise test in evaluating the function of the heart and lungs, and thereby predicting lung and heart complications, was examined in elderly patients. The clinical history, results of physical examination, electrocardiogram, chest X-ray, blood chemistries, lung function test, exercise tests, and risk factors for heart disease were assessed prior to surgery in 177 patients, aged 65 years and older. There were major complications involving the lungs in 24 patients, the heart in 25 patients, and the heart and lungs in 39 patients. The inability to perform bicycle exercise in a supine or lying down position at a heart rate of 99 beats per minute was an effective predictor of lung, heart, and combined heart-lung complications. Among 108 patients who were capable of performing this exercise, there were complications involving the heart and lungs in 10 patients; one death occurred. Among 69 patients who were unable to perform the exercise, heart and lung complications occurred in 29 patients, resulting in five deaths. The findings demonstrate that the supine bicycle test provides an indication of risk for developing heart and lung complications resulting from abdominal and non-heart-related chest surgery in elderly patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Aged, Elderly, Complications and side effects, Physiological aspects, Surgery, Postoperative complications, Lungs, Lung, Heart, Exercise tests

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