CardioExchange Archive

Shorter Hospital Stays Not Necessarily Better: Shorter hospital stays for heart failure patients have resulted in fewer deaths in the hospital, but at the cost of more readmissions, leading researchers to speculate that “because length of stay has substantially decreased, improvement is less than what might be suggested by in-hospital mortality.” Writing in JAMA, Hector Bueno and colleagues (including senior author Harlan Krumholz, who is the editor-in-chief of CardioExchange) analyzed Medicare data from nearly 7 million heart failure hospitalizations from 1993 until 2006. They conclude that heart failure patients “may benefit from more attention to the care and outcomes in the early transition period after hospital discharge.”

Shorter Delays to Reperfusion Are Better: To assess the impact of time to reperfusion, Laurie Lambert and colleagues analyzed data from nearly all STEMI patients treated in Quebec for 6 months. Of the patients who underwent reperfusion, 78.6% received PCI and 21.4% fibrinolysis. When both treatment groups were combined, treatment beyond the recommended time limit was associated with a significantly higher risk for death at 30 days and a similar trend at 1 year when compared to timely treatment. In their paper in JAMA, the authors write that “at the regional level, after adjustment, each 10 percent increase in patients treated within the recommended time was associated with a decrease in the region-level odds of overall 30-day mortality.” In an accompanying editorial, Deepak Bhatt writes that “barring contraindications, prompt fibrinolysis (and transfer to a PCI center) would be preferred in many patients if the alternative is untimely primary PCI.”

Better Use of Bleeding Avoidance Strategies in PCI: Steven Marso and colleagues analyzed data from 1.5 million PCI patients from hospitals enrolled in the NCDR (National Cardiovascular Data Registry) to examine the use of bleeding avoidance strategies. Manual compression was used in 35% of cases, closure devices in 24%, bivalirudin in 23%, and the combination of a closure device and bivalirudin in 18%. The rate of bleeding was 2.8% for manual compression, 2.1% for closure devices, 1.6% for bivalirudin, and 0.9% for combination therapy. The investigators reported an unusual paradox— patients at high risk for bleeding were less likely to receive combination therapy. In their JAMA paper, they write that their findings “emphasize the opportunity to improve the safety of PCI and to further explore cost efficacy by directing such strategies to those patients most likely to benefit from them.”