Worries regarding short length of stay (LOS) adversely impacting quality of care prompted
us to assess the relation between hospital LOS and inpatient guideline adherence in
patients with acute coronary syndrome. We used the American Heart Association's Get
with The Guidelines (GWTG)—Coronary Artery Disease data set. Data were collected from
January 2, 2000, to March 21, 2010, for patients with acute coronary syndrome from
405 different sites. Of the 119,398 patients in the study, the mean LOS was 5.5 days
with a median of 4 days. There was no difference in the LOS on the basis of hospital
size, hospital type, or cardiac surgery availability. The population with an LOS <4 days
were younger (63.8 ± 14.1 vs 70 ± 14.5, p <0.0001), men (63.8% vs 55.3%, p <0.0001)
and had fewer clinical co-morbidities. The overall adherence was high in the GWTG
participating hospitals. Those with the LOS <4 days were more likely to receive aspirin
(adjusted odds ratio [OR] 1.12, 95% CI 1.06 to 1.19; p <0.001), clopidogrel (OR 1.77,
95% CI 1.60 to 1.95; p <0.001), lipid-lowering therapy if indicated (OR 1.13, 95%
CI 1.05 to 1.21; p <0.001), angiotensin-converting enzyme inhibitor or angiotensin
receptor blocker for left ventricular systolic dysfunction (OR 1.10, 95% CI 1.01 to
1.21; p = 0.04) and smoking cessation counseling (OR 1.17, 95% CI 1.1 to 1.24; p <0.001)
compared to those with the LOS ≥4 days. In contrast, those with the LOS <4 days were
less likely to receive beta blockers (OR 0.88, 95% CI 0.84 to 0.93; p <0.001). The
odds of receiving defect-free care were greater for patients with the LOS <4 days
(OR 1.15, 95% CI 1.1 to 1.21; p <0.001). In conclusion, in GWTG participating hospitals,
a shorter LOS did not appear to adversely affect adherence to discharge quality of
care measures.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Heart disease and stroke statistics–2012 update: a report from the American Heart Association.Circulation. 2012; 125: e2-e220
- ACC/AHA 2008 performance measures for adults with ST-elevation and nonST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on performance measures (writing committee to develop performance measures for ST-elevation and non-ST-elevation myocardial infarction): developed in collaboration with the American Academy of Family Physicians and the American College of Emergency Physicians: endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation, Society for Cardiovascular Angiography and Interventions, and Society of Hospital Medicine.Circulation. 2008; 118: 2596-2648
- 2013 ACCF/AHA guideline for the Management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2013; 61: e78-e140
- 2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/non–ST-elevation myocardial infarction (updating the 2007 guideline and replacing the 2011 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2012; 60: 645-681
- Guideline adherence after ST-segment elevation versus non-ST segment elevation myocardial infarction.Circ Cardiovasc Qual Outcomes. 2012; 5: 654-661
- Achievement of guideline-concordant care and in-hospital outcomes in patients with coronary artery disease in teaching and nonteaching hospitals: results from the Get With The Guidelines-Coronary Artery Disease program.Circ Cardiovasc Qual Outcomes. 2013; 6: 58-65
- Twenty-year trends in the incidence of stroke complicating acute myocardial infarction: Worcester Heart Attack study.Arch Intern Med. 2008; 168: 2104-2110
- Relation of length of hospital stay in acute myocardial infarction to postdischarge mortality.Am J Cardiol. 2008; 101: 428-434
- Using Get With The Guidelines to improve cardiovascular secondary prevention.Joint Comm J Qual Saf. 2003; 29: 539-550
- Association between hospital process performance and outcomes among patients with acute coronary syndromes.JAMA. 2006; 295: 1912-1920
- Get with the Guidelines Steering Committee and Hospitals.Am J Cardiol. 2008; 102: 1693-1697
Article Info
Publication History
Published online: November 05, 2015
Accepted:
October 22,
2015
Received in revised form:
October 22,
2015
Received:
June 24,
2015
Footnotes
See page 205 for disclosure information.
Identification
Copyright
© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
