Discharge Policy and Reperfusion Therapy in Acute Myocardial Infarction

Treatment of patients with acute myocardial infarction (MI) has improved over time and the duration of hospital stay has considerably decreased. Early hospital discharge after MI has been promoted for over 25 years. However, the meaning of “early” evolved over time. In the early eighties, before the widespread introduction of reperfusion therapy, patients were hospitalised for approximately 3 weeks and early discharge implemented a reduction to 7 days. Nowadays, the average hospital stay in the Netherlands amounts up to 8 days and “early” discharge is after 3-5 days. Evidently, in a cost-conscious environment hospitalisation should not be extended beyond the patient’s clinical needs. Still, evidence exists that further reduction in length of hospital stay can be achieved compared to current practice. In particular, after primary PCI that nowadays is the choice of reperfusion therapy especially in the Netherlands, when coronary anatomy and left ve! ntricular function are known, discharge can be safely effectuated after a few days. In particular, because early hospital discharge has been associated with improved physical and psychological outcome, especially in elderly subjects. We developed and validated different early discharge strategies in unselected patients with acute myocardial infarction in different patient cohorts. Over time reperfusion therapy changed and we evaluated the consequences for discharge policy and validated our allocation model of reperfusion therapy with 10 years of follow-up. Furthermore, we investigated the psychological impact of early discharge.