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Duration of Hospital Stay has shortened for Patients with Heart Attack

CHICAGO From 1986 to 1999, the average length of hospital stay for patients with acute myocardial infarction (AMI, or heart attack) has significantly declined, without increases in death rates after discharge, according to an article in the April 12 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

According to the article, the length of hospital stay for patients with AMI has evolved from prolonged bed rest and rehabilitation of more than six weeks in the 1950s, to hospital stays of less than one week today. In the United States, the typical length of stay for patients with an uncomplicated AMI is approximately five days, the article states. However, considerable variation exists in the duration of hospitalization for patients with AMI.

Frederick A. Spencer, M.D., from the University of Massachusetts Medical School, Worcester, and colleagues conducted a population-based study to describe trends in duration of hospitalization after AMI and patient characteristics associated with variations in length of stay, and the effects of shorter times in the hospital on death rates at one and three months after discharge.

The researchers studied data from 4,551 patients discharged after AMI from all Worcester, Mass. hospitals in eight annual periods from 1986 to 1999.

The researchers observed significant declines in the average length of stay between the 1986-1988 period (which included 896 patients) and the 1997-1999 period (which included 1,330 patients), from 11.7 days in the earlier period to 5.9 days in the later. Patients who stayed in the hospital longer were more likely to be older, female, and have cardiac complications. Patients enrolled in a health maintenance organization, Medicare, Medicaid, or with no insurance were less likely to have an increased length of stay. Crude mortality rates did not change appreciably between the earlier and later periods (one month mortality, 3.5 percent vs. 2.7 percent, respectively, and three month mortality, 7.0 percent vs. 5.9 percent, respectively). However, patients who stayed in the hospital longer than 14 days had increased odds of death within the 30- or 90-day post discharge time period than patients who stayed six to eight days (about twice as likely to die).

The average length of stay declined from approximately 12 days in the 1986-1988 period to six days in the 1997-1999 period, the authors write. However, we found no negative association between declining length of stay and short-term mortality after hospital discharge for AMI.

Much of the observed decline in hospital length of stay may be attributed to improvements in the management of AMI, including increased use of coronary reperfusion modalities [techniques to restore blood and oxygen flow to the heart muscle], write the researchers.

Arch Intern Med. 2004;164:733-740. Available www.archinternmed.com.

Editors Note: This study was supported by a grant from the National Heart, Lung, and Blood Institute, Bethesda, Md.

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