Clinical research study
Declining Length of Stay for Patients Hospitalized with AMI: Impact on Mortality and Readmissions

https://doi.org/10.1016/j.amjmed.2010.05.018Get rights and content

Abstract

Background

Length of hospital stay after acute myocardial infarction decreased significantly in the 1980s and 1990s. Whether length of stay has continued to decrease during the 2000s, and the impact of decreasing length of stay on rehospitalization and mortality, is unclear. We describe decade-long (1995-2005) trends in length of stay after acute myocardial infarction, and examine whether declining length of stay has impacted early rehospitalization and postdischarge mortality in a population-based sample of hospitalized patients.

Methods

The study sample consisted of 4184 patients hospitalized with acute myocardial infarction in a central New England metropolitan area during 6 annual periods (1995, 1997, 1999, 2001, 2003, 2005).

Results

The average age of the study sample was 71 years, and 54% were men. The average length of stay decreased by nearly one third over the 10-year study period, from 7.2 days in 1995 to 5.0 days in 2005 (P <.001). Younger patients (<65 years), men, and patients with an uncomplicated hospital stay had significantly shorter lengths of stay than respective comparison groups. Lengths of stay shorter than the median were not associated with significantly higher odds of hospital readmission at 7 or 30 days postdischarge, or with mortality in the year after discharge. In contrast, longer lengths of stay were associated with significantly higher odds of short-term mortality. These findings did not vary by year under study.

Conclusions

Length of stay in patients hospitalized for acute myocardial infarction decreased significantly between 1995 and 2005. Declining length of stay is not associated with an increased risk for early readmission or all-cause mortality.

Section snippets

Methods

Data for this study were derived from the Worcester Heart Attack Study.11, 12, 13 This is an ongoing population-based investigation that is examining long-term trends in the incidence, hospital, and postdischarge case-fatality rates of acute myocardial infarction among residents of the Worcester (MA) metropolitan area hospitalized at all area medical centers. The details of this study have been described previously.12, 13 In brief, the medical records of area residents (2000 census estimate = 

Length of Hospital Stay

There have been marked changes in the distribution of length of stay for greater Worcester residents hospitalized with acute myocardial infarction during the period under study (1995-2005) (Figure). The average length of stay decreased by more than 2 days over the 10-year study period from 7.2 days in 1995 to 5.0 days in 2005, corresponding to a 30% overall decrease in length of stay over this period. In 1995, <20% of patients were hospitalized for <5 days compared with approximately 60% of

Discussion

The results of this population-based observational study suggest that the average length of stay in patients hospitalized with validated acute myocardial infarction in a large New England community decreased between 1995 and 2005. Additionally, we found that shorter lengths of stay did not adversely affect the risk of hospital readmission 7 and 30 days after hospital discharge or mortality in the 30 and 90 days following discharge.

A number of studies have shown that, despite the advanced age

Conclusions

New classifications of patients at low risk for poor outcomes (eg, uncomplicated acute myocardial infarction) may help identify patients who may benefit from early hospital discharge.23 The results of this population-based study show that shorter hospital stays are not associated with higher rates of rehospitalization or of postdischarge mortality. However, further studies are needed to identify the optimal length of hospital stay for patients who have experienced an acute myocardial infarction.

Acknowledgment

This research was made possible by the cooperation of participating hospitals in the Worcester metropolitan area and through funding provided by the National Institutes of Health (RO1 HL35434).

References (23)

  • N.I. Parikh et al.

    Long-term trends in myocardial infarction incidence and case fatality in the National Heart, Lung, and Blood Institute's Framingham Heart Study

    Circulation

    (2009)
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    Funding: This research was funded by the National Institutes of Health (RO1 HL35434).

    Conflict of Interest: The authors have no conflicts of interest to report.

    Authorship: All authors had access to the data and a role in writing the manuscript.

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