After PCI, Immediate Retransfer to Referring Hospital Safe for ACS Patients
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Selected patients with acute coronary syndromes (ACS) who are initially transferred for coronary angiography or percutaneous coronary intervention (PCI) can be safely transferred back to their referring hospital on the same day, according to a study published online March 21, 2013, ahead of print in European Heart Journal: Acute Cardiovascular Care. However, the strategy relies on immediate written reports and good communication.
Jack Gunnar Andersen, of Oslo University Hospital (Ullevål, Norway), and colleagues conducted a prospective study of 399 consecutive patients with suspected ACS (30% admitted for unstable angina and 70% for NSTEMI) who were referred within 200 km of their PCI center. Patients were randomly assigned to ordinary (n = 206) or fast-track care (n = 193), which involved evaluating patients for possible same-day transfer back to their referring hospital.
Within the fast-track group, 95% of patients (all but 9) were able to be transferred back to their referring hospital the same day as their procedure.
Overall, 9 patients (2.2%) in the study experienced a major event, 5 of which occurred within 24 hours of the procedure. Three patients in the ordinary-care group and 2 in the fast-track group experienced a major event within 24 hours; events included 2 deaths, 2 episodes of major bleeding, and 2 MIs. From 24 hours to 30 days, the control group had 1 vascular noncardiac death and 1 major bleeding event, while the fast-track group had 2 MIs.
System Eases PCI Center Overload
In Norway, PCIs are centralized to only a few hospitals and the capacity for overnight stay is limited, Andersen told TCTMD in an e-mail communication.
“We believe that most patients with suspected ACS, both unstable angina and NSTEMI, who need coronary intravascular examination and/or intervention could be included [in this strategy],” Andersen said. “Individual evaluation by an experienced cardiologist is required before retransfer, and the result is that few patients actually need overnight stay at the PCI center.”
This system would allow angiography and PCI to be centralized without requiring a large intensive care unit and cardiology ward, Andersen said.
Situation in United States Varies
In contrast, many PCI centers in the United States have the capacity to accommodate these patients, reported Harlan M. Krumholz, MD, SM, of the Yale School of Medicine (New Haven, CT).
“Many new models are emerging for how to care for patients,” Dr. Krumholz said in a telephone interview with TCTMD. “This method addressed some of the concerns that referring hospitals have that they will never see their patients again.” In addition, the fast-track approach could accommodate those patients who wish to stay closer to home or prefer their local hospitals so that friends and family can more easily visit, he said.
Although the study shows that retransfer can be done safely, “it doesn’t mean that everybody can get results,” Dr. Krumholz added. The strategy would require communication, collaboration, and supportive systems to ensure good patient handoffs.
A program like this could theoretically be established in the United States, he noted, but currently there is no “good system of coordination between referring and receiving hospitals.”
Source:
Andersen JG, Kløw N-E, Johansen O. Safe and feasible immediate retransfer of patients to the referring hospital after acute coronary angiography and percutaneous coronary angioplasty for patients with acute coronary syndrome. Eur Heart J Acute Cardiovasc Care. 2013;Epub ahead of print.
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Disclosures
- Andersen and Dr. Krumholz report no relevant conflicts of interest.
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