Factbilidade da implementação de um programa de alta precoce pós-angioplastia em população de baixo risco em um hospital quaternário da rede pública: um estudo piloto
Factbilidade da implementação de um programa de alta precoce pós-angioplastia em população de baixo risco em um hospital quaternário da rede pública: um estudo piloto
Data
2022-03
Autores
Silveira, Gustavo Medeiros da
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
Introdução: Em um cenário de demanda crescente por intervenções cardiovasculares complexas, impõe-se a criação de políticas de gerenciamento hospitalar voltadas para contenção de gastos, preservando a eficácia clínica, segurança e satisfação dos pacientes submetidos aos procedimentos. Estudos anteriores demonstraram significativa redução de custos relacionados à angioplastia coronariana com a inclusão de pacientes selecionados com baixo risco de complicações em um programa de alta hospitalar no mesmo dia. Embora bem estabelecida na prática da cardiologia intervencionista mundial, a alta hospitalar precoce permanece pouco estudada e difundida no Brasil.
Objetivo: Avaliar a factibilidade da implementação de um programa de alta hospitalar precoce (menos de 24 horas) pós-angioplastia coronariana para uma população selecionada de indivíduos de baixo risco em um hospital quaternário da rede pública.
Métodos: Ensaio clínico não randomizado com pacientes selecionados (baixa complexidade clínica e anatômica) encaminhados para realização de angioplastia coronariana eletiva em um único centro, implementando a alta hospitalar 6 horas após o término do procedimento, abdicando do habitual período de observação intra-hospitalar de 24 horas. Avaliou-se a ocorrência de eventos cardíacos adversos, acidente vascular cerebral (AVC) ou necessidade de reinternação nos 30 dias após o procedimento.
Resultados: Entre outubro de 2019 e fevereiro de 2021 foram realizadas 320 angioplastias coronarianas eletivas, sendo recrutados 34 indivíduos candidatos à alta hospitalar precoce. Destes, identificaram-se critérios de exclusão pós-angioplastia em 2 pacientes que, desta forma, permaneceram em ambiente intra-hospitalar durante o período habitual (24 horas). Entre os 32 remanescentes, evidenciou-se um Syntax Score médio foi de 10,3 ± 4,7, sendo realizado o tratamento (angioplastia) de um único vaso em 84,4% dos casos. Em 30 dias de acompanhamento, não ocorreram eventos cardíacos adversos maiores (óbito, infarto do miocárdio e necessidade de revascularização do vaso-alvo), AVC, óbito por qualquer causa, infarto agudo do miocárdio, necessidade de nova intervenção coronariana ou mesmo de internação hospitalar em quaisquer dos indivíduos selecionados.
Conclusão: A ausência absoluta de eventos adversos cardiovasculares e complicações globais posteriores à alta hospitalar precoce na população selecionada sugere ser esta uma alternativa viável em angioplastias eletivas não complicadas em pacientes de baixo risco e baixa complexidade anatômica.
Palavras chave: intervenção coronariana percutânea, alta do paciente, tempo de hospitalização, segurança do paciente.
Introduction: Coronary angioplasty has become the most requested form of myocardial revascularization, calling for administrative policies aimed at reducing hospitalization costs, while preserving the clinical efficacy, safety, and satisfaction of patients. Previous studies demonstrated that same-day hospital discharge of patients with low risk of complications following coronary angioplasty is safe and effective in reducing costs. Though this cost-saving measure is widely accepted and has been successfully implemented in health programs worldwide, it has yet to be investigated and reproduced in Brazil. Objective: To assess the feasibility of early hospital discharge (within 24h) of low-risk patients after percutaneous coronary intervention in a public quaternary hospital in Rio de Janeiro. Methods: Non-randomized clinical trial in which patients with low clinical and anatomical complexities referenced for elective coronary angioplasty in a single center were submitted to early hospital discharge, within 6h, instead of the routine 24h hospitalization period. The incidence of adverse cardiac events, stroke and readmission rates in the 30 days following the procedure was evaluated. Results: From October 2019 to February 2021, 320 patients underwent elective coronary angioplasty procedures, of whom 34 were eligible for early hospital discharge. 2 of these patients met exclusion criteria after the procedure and remained at the hospital for the regular 24h period. Within the 32 participants enrolled in the study (mean age, 62 ± 6.3 years; 21 [65.6%] males), single-vessel angioplasty was performed in 84,4% of cases, with a mean Syntax Score of 10,3 ± 4,7. In the 30 days following the procedure, there were no adverse cardiac events (death, myocardial infarction, and need for revascularization of target-vessel), stroke, all-cause deaths, need for new coronary intervention or hospital readmissions. Conclusion: The absence of adverse cardiovascular events and general complications suggests that early hospital discharge is a feasible cost-saving alternative in patients with low clinical and anatomical complexities, following uncomplicated elective coronary angioplasty. Keywords: percutaneous coronary intervention, patient discharge, length of stay, patient safety.
Introduction: Coronary angioplasty has become the most requested form of myocardial revascularization, calling for administrative policies aimed at reducing hospitalization costs, while preserving the clinical efficacy, safety, and satisfaction of patients. Previous studies demonstrated that same-day hospital discharge of patients with low risk of complications following coronary angioplasty is safe and effective in reducing costs. Though this cost-saving measure is widely accepted and has been successfully implemented in health programs worldwide, it has yet to be investigated and reproduced in Brazil. Objective: To assess the feasibility of early hospital discharge (within 24h) of low-risk patients after percutaneous coronary intervention in a public quaternary hospital in Rio de Janeiro. Methods: Non-randomized clinical trial in which patients with low clinical and anatomical complexities referenced for elective coronary angioplasty in a single center were submitted to early hospital discharge, within 6h, instead of the routine 24h hospitalization period. The incidence of adverse cardiac events, stroke and readmission rates in the 30 days following the procedure was evaluated. Results: From October 2019 to February 2021, 320 patients underwent elective coronary angioplasty procedures, of whom 34 were eligible for early hospital discharge. 2 of these patients met exclusion criteria after the procedure and remained at the hospital for the regular 24h period. Within the 32 participants enrolled in the study (mean age, 62 ± 6.3 years; 21 [65.6%] males), single-vessel angioplasty was performed in 84,4% of cases, with a mean Syntax Score of 10,3 ± 4,7. In the 30 days following the procedure, there were no adverse cardiac events (death, myocardial infarction, and need for revascularization of target-vessel), stroke, all-cause deaths, need for new coronary intervention or hospital readmissions. Conclusion: The absence of adverse cardiovascular events and general complications suggests that early hospital discharge is a feasible cost-saving alternative in patients with low clinical and anatomical complexities, following uncomplicated elective coronary angioplasty. Keywords: percutaneous coronary intervention, patient discharge, length of stay, patient safety.
Description
Palavras-chave
Intervenção coronariana percutânea, Alta do paciente, Tempo de hospitalização, Segurança do paciente, Percutaneous coronary intervention, Patient discharge, Length of stay, Patient safety
Citação
Silveira GM. Factbilidade da implementação de um programa de alta precoce pós-angioplastia em população de baixo risco em um hospital quaternário da rede pública: um estudo piloto. Dissertação [Mestrado Profissional em Ciências Cardiovasculares]. Instituto Nacional de Cardiologia; 2022.