An evaluation of same day discharge following percutaneous coronary intervention: analysing linked observational data

Abstract

Same day discharge (SDD) following elective percutaneous coronary intervention (PCI) is increasingly common, primarily driven by financial pressures for cost-savings. However, extensive adoption of SDD is delayed in many healthcare systems worldwide, as clinicians remain sceptical towards the consequences of SDD on patients’ safety. Numerous randomised clinical trials, observational studies and meta-analyses evaluating the safety and feasibility of SDD following PCI have shown that SDD is not inferior comparing to overnight stay in terms of adverse outcomes. Nevertheless, evidence to-date is limited. Using a national UK PCI registry (BCIS registry), this thesis presents unique work and has implemented novel analysis, aiming to deliver important information on SDD from a national healthcare perspective. Specifically, this thesis aimed to provide answers for three research questions: (1) What is the medical profile of all or more complex elective PCI patients that underwent SDD and how this changed over time as SDD became the standard of care? (2) Which are the major predictors of SDD and how similar/ different these were across different regions in the UK? (3) Has the increase of SDD practice to higher risk patients placed these patients at increased risk in terms of 30-days mortality? The findings of this thesis demonstrate that SDD has evolved to be the predominant standard of care following elective PCI in the UK (Chapter 3). SDD also increased substantially for elective patients with higher complexity, including left main disease (Chapter 5), rotational atherectomy (Chapter 6) and chronic total occlusion (Chapter 7), overnight stay remained the standard practice of care. All analyses conducted showed that, while older patients, with increased medical burden, more comorbidities and higher complexity were more likely to be admitted for overnight observation, these characteristics became more prevalent within the SDD group over time. Additionally, there was no evidence of increased mortality risk for the patients that underwent SDD, as the 30-day mortality rates were not higher than expected. Nevertheless, within a common finding of this thesis is that uptake of SDD varied widely between regions of the UK, demonstrating lack of clinical guidelines surrounding SDD practice following PCI. Overall, this thesis has begun to formulate the evidence around a SDD change to the standard routine care in practice. Further research is required to ensure the safety of such a change in terms of other major adverse cardiovascular outcomes and to evaluate the benefits for both patients and healthcare systems.

Date of Award	31 Dec 2020
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Evangelos (Evan) Kontopantelis (Supervisor), Matthew Sperrin (Supervisor) & Glen Martin (Supervisor)