MONDAY, April 12, 2004 (HealthDayNews) -- Today's heart attack patients are spending substantially less time in the hospital than they once did, but are living just as long once they're discharged, a new study has found.
In the 1950s, people suffering from a heart attack spent an average of six weeks in the hospital, but now the typical stay is less than one week, according to a report in the April 12 issue of the Archives of Internal Medicine.
Yet despite dramatically shorter hospital stays, there hasn't been any change in the death rate among patients after being released from the hospital.
In the last 15 years, the number of patients discharged from the hospital in less than six days has increased tenfold, said study author Dr. Frederick A. Spencer, director of the cardiac care unit at the University of Massachusetts Medical School.
A combination of better care -- for example, using techniques that open clogged arteries, such as angioplasty and stenting -- and financial pressure to cut costs are the reasons for shorter stays, Spencer said.
With better technology and training, doctors can prevent further heart attacks and prevent complications, so it is not a surprise that patients don't need as much time in the hospital, he added.
In addition, there are more pressures from insurers and hospitals to get patients released, Spencer explained. "To many of my residents, the mindset is that day four is now the time to discharge heart attack patients," he added.
"This means that we are sending more and more patients with complicated heart attacks home early," Spencer said. "We have to make sure that the pendulum doesn't swing too far in this direction."
In the study, Spencer's team collected data on 4,551 heart attack patients seen between 1986 and 1999. In addition to the trend of shorter hospital stays, the researchers found that among patients discharged after less than six days there was no increase in death after 30 or 60 days.
However, there were more deaths among heart attack patients who remained in the hospital for more than two weeks. This is probably because those patients had more severe conditions, Spencer said.
Healthy people tend to go home earlier and have better outcomes, he added.
In this study, 40 percent of the patients were older than 75 and about 25 percent had heart failure during their hospital stay. "Even though they were older and had heart failure, they were still going home in less than four days," Spencer said.
However, this study does not show the number of re-hospitalizations or other complications after discharge, Spencer added. In addition, there is no data as to whether patients were comfortable going home early or how they functioned once home, he said.
"You could take this study to say that early discharge after a heart attack is safe," Spencer said. "But what the study shows is that more patients with complicated heart attacks are being discharged early, and we don't have data to support that that's always safe."
Dr. Bertram Pitt, a professor of internal medicine at the University of Michigan School of Medicine, said that "more and more people are being discharged early and some of them don't meet the criteria for a low-risk heart attack."
However, the data is reassuring in that doctors are not getting into terrible trouble, because more people are getting angioplasty and other procedures early, he noted.
But there are also a lot of older people and other high-risk patients being discharged early, he added. To settle the issue, a large trial is needed that would release some patients early while others remained in the hospital longer, Pitt said.
Right now, it is not known how safe early release is among older and high-risk patients, he said, "but this study says that somehow we are getting away with it."
More information
The American Heart Association can tell you what happens after a heart attack, while the National Heart, Lung, and Blood Institute has information on the signs of a heart attack.
