MP-3 - EARLY DISCHARGE PATHWAY IN PATIENTS WITH STEMI: INITIAL EXPERIENCE OF A NEW CLINICAL PATHWAY AT LONDON HEALTH SCIENCES CENTRE

Background: London Health Sciences Centre (LHSC) implemented a clinical pathway in January 2023 to facilitate early hospital discharge (EHD) within 48 hours post primary percutaneous coronary intervention (PCI) for low-risk ST Elevation Myocardial Infarction (STEMI) patients. Prior studies have defined low-risk STEMI patients and demonstrated safety of EHD in this population. This quality improvement study characterizes the common exclusion criteria, barriers, safety profile and patient satisfaction of EHD at a Canadian tertiary care hospital.

METHODS AND RESULTS: All patients presenting with STEMI to LHSC between January 9th, 2023, and March 31st, 2024 were prospectively identified. Patient characteristics, potential EHD barriers and 30-day hospital representation rates were collected. We administered a patient satisfaction survey by telephone 4-8 weeks post-discharge, with questions adapted from the standardized Canadian Patient Experiences Survey. We defined those discharged < 48 hours as the EHD-cohort (EHDC), and those discharged after 48 hours as the non-EHD-cohort (non-EHDC). Chi-square tests and Mann-Whitney U tests were used for comparison of patient characteristics. We used logistic regression to examine the relationship between EHD and potential barriers to EHD (timing of presentation, time to echocardiogram and infarct territory).

Of 433 patients with STEMIs, 65% (n=282) were ineligible for EHD (Figure 1). Most patients (76%) were ineligible due to revascularization (29%) or infarct-related (47%) considerations. The remaining 35%(n=151) were eligible for EHD of which 72%(n=109) were in the EHDC.

Timing of presentation was a barrier to EHD, 82% of patients who presented in the afternoon were discharged early versus 61% of patients who presented in the morning or overnight (odds ratio=3.5; 95% confidence interval 1.565-7.828; p=0.002). Access to echocardiogram within 36 hours (95% vs. 91%, p=0.196) and infarct territory (anterior infarctions 28% vs. 31%, p=0.349) were not barriers to EHD. Similar 30-day re-admissions and emergency department (ED) visits in the EHDC and non-EHDC (9% vs. 12%, p=0.736) were noted (Table 1).

The patient satisfaction survey (response rate EHDC 85%, non-EHDC 92%) identified overall satisfaction (96% vs. 95%, p=.841), perception of length of stay (91 vs. 82%, p=.149), and intention to attend cardiac rehabilitation (63% vs. 67%, p=0.727) were similar in both groups.


Conclusion: Common reasons for exclusion from EHD are infarct and coronary anatomy related. We identified timing of presentation as a potential barrier to EHD, particularly morning or evening presentations, which can potentially be addressed through improving discharge planning. We did not identify any evident safety concerns and patients were highly satisfied following an EHD pathway.