title: Prospective study of early discharge after acute myocardial infarction (SHORT)
abstract: OBJECTIVE
  To identify, without additional investigation, a large group of myocardial infarction patients at low risk who would qualify for early discharge.
  
  
  METHODS
  The decision rule was developed in 647 unselected patients with consecutively admitted myocardial infarction, and validated in 825 others. Daily event-rates were calculated for major (death, ventricular fibrillation, recurrent infarction, heart failure, advanced AV-block) and minor (unstable angina and rhythm-abnormalities) cardiac complications.
  
  
  RESULTS
  Patients free from major complications until day 7 (44% of all patients) were found to constitute a very low risk group and thus would qualify for discharge at day 7. Of the 39% of patients with an uncomplicated infarction (low risk) in the validation group, 31% were discharged at day 7, while 8% stayed longer because of non-cardiac co-morbidity, for social reasons or logistic problems. No major adverse event occurred within 7 days after hospital discharge and only 1.8% developed complications within 1 month. The median duration of hospital stay for all in-hospital survivors was 7 days compared to 10 days in the control group.
  
  
  CONCLUSIONS
  Prospective application of the early discharge decision rule, based upon simple clinical variables and without the need for additional non-invasive and/or invasive tests, resulted in a significant reduction of hospital stay. The decision rule correctly classified patients into high and low risk groups and appeared feasible and safe. Its efficacy was demonstrated by its ability to identify a large group of post infarction survivors at low risk for complications during follow-up.
authors.affiliation: Rotterdam Heartcenter, location Thoraxcenter, University Hospital Rotterdam Dijkzigt, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: van der Vlugt
authors.forename: H
authors.initials: H
authors.lastname: Boersma
authors.forename: C M
authors.initials: CM
authors.lastname: Leenders
authors.forename: G A
authors.initials: GA
authors.lastname: Pop
authors.forename: M J
authors.initials: MJ
authors.lastname: Veerhoek
authors.forename: M L
authors.initials: ML
authors.lastname: Simoons
authors.forename: J W
authors.initials: JW
authors.lastname: Deckers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003661:Decision Support Techniques; D005240:Feasibility Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000534:rehabilitation*; D011446:Prospective Studies; D012307:Risk Factors