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Volume 342:749-755 March 16, 2000 Number 11 Next

	Full Text PDF Editorial by Antman, E. M. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Reducing the length of hospitalizations can reduce short-term costs, but there are few data on the long-term clinical and economic consequences of early discharge after uncomplicated myocardial infarction.

Methods Using data from the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO-1) trial, we identified 22,361 patients with acute myocardial infarction who had an uncomplicated course for 72 hours after thrombolysis. Then, using a decision-analytic model, we examined the cost effectiveness of an additional day of hospitalization in this group. We defined incremental survival attributable to another day of monitored hospitalization, on the basis of the rate of resuscitation after cardiac arrest between 72 and 96 hours. Lifetime survival curves for each group in the decision-analytic model were estimated from one-year survival data from GUSTO-1.

Results Of the patients with an uncomplicated course within 72 hours after thrombolysis, 16 had ventricular arrhythmias during the next 24 hours; 13 of these patients (81 percent) survived for at least 24 hours. On average, another 0.006 year of life per patient could be saved by keeping patients with an uncomplicated course in the hospital another day. At a cost of $624 for hospital and physicians' services, extending the hospital stay by another day would cost $105,629 per year of life saved. In sensitivity analyses, it was found that a fourth day of hospitalization would be economically attractive only if its cost could be reduced by more than 50 percent or if a high-risk subgroup could be identified in which the estimated survival benefit would be doubled.

Conclusions Hospitalization of patients with uncomplicated myocardial infarction beyond three days after thrombolysis is economically unattractive by conventional standards.

Source Information

From the Duke Clinical Research Institute, Durham, N.C. (L.K.N., E.L.E., R.M.C., T.D.T., C.L.N., E.D.P., D.B.M.); the University of Alberta, Edmonton, Canada (P.W.A.); Universitaire Ziekenhuizen Leuven, Leuven, Belgium (F.V.W.); Green Lane Hospital, Auckland, New Zealand (H.D.W.); and the Cleveland Clinic Foundation, Cleveland (E.J.T.).

Address reprint requests to Dr. Newby at the Duke Clinical Research Institute, P.O. Box 17969, Durham, NC 27715-7969, or at newby001{at}mc.duke.edu.

Full Text of this Article

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