Early discharge after acute myocardial infarction in the current clinical practice. Community data from the AMI-Florence Registry, Italy.
BACKGROUND
Clinical trials suggested feasibility and safety of early discharge after ST-segment elevation acute myocardial infarction (STEMI) for selected patients. Current United States and European guidelines recommend early discharge for uncomplicated AMI. The present study was aimed to assess early discharge in the current clinical practice for STEMI patients.


METHODS
Patients enrolled in the AMI-Florence Registry (Italy), a prospective, observational, population-based study performed in the early 2000s, were analysed. The proportion of STEMI patients eligible for early discharge and of those actually discharged early, patient features influencing early discharge and outcomes (mortality, reinfarction or urgent revascularization during the first year of follow-up) were assessed.


RESULTS
Of 751 STEMI patients, 59% were classified as eligible for early discharge, according to previously established criteria. Among patients considered eligible, those actually discharged early dropped from 33.1% in age <70 years to 15.9% in age 70-79 years and to 11.7% in age 80+ years. Of eligible patients, 26% were actually discharged within 4 days. Age 70+ years (reference: 69 years or younger; 70-79 years: OR: 0.40, 95% CI: 0.22-0.73; 80+ years: OR: 0.33, 95% CI: 0.14-0.76) and diabetes (OR: 0.48, 95% CI: 0.24-0.98) were negative independent predictors; and coronary reperfusion (OR: 2.92, 95% CI: 1.54-5.53) or firstly admitted to teaching hospital (OR: 1.68, 95% CI: 1.03-2.74) were positive predictors, of the multivariate probability of being early discharged. Among patients eligible for early discharge, 1-year and 3-year mortality did not differ significantly between patients actually, and not, early discharged. After 1 year of follow-up, no deaths were observed among patients early discharged.


CONCLUSIONS
This study confirms, in a setting of current clinical practice, the reliability of criteria for identifying patients eligible for early discharge. Besides, the results confirmed the safety of this practice in selected patients. About 1/4 of eligible patients are actually early discharged, confirming the existence of important opportunities to improve the efficiency in STEMI management.
Barchielli
Alessandro
A
Epidemiology Unit, Local Health Unit Florence, Via di San Salvi 12, 50135 Florence, Italy. alessandro.barchielli@asf.toscana.it
Balzi
Daniela
D
Marchionni
Niccolò
N
Carrabba
Nazario
N
Margheri
Massimo
M
Santoro
Giovanni M
GM
Olivotto
Iacopo
I
Buiatti
Eva
E
D000368:Aged; D005260:Female; D006801:Humans; D007558:Italy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000628:therapy*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012042:Registries; D013997:Time Factors