Predictors of Hospital Length of Stay Prolongation in Patients with ST-Segment Elevation Myocardial Infarction in Cardiovascular Care Unit Sardjito General Hospital
Author : I.H. Sulistya , H. P. Bagaswoto , N. Taufiq , B. Y. Setianto
Upload Date : 19-04-2018
Background: Patients with acute coronary syndrome, particularly ST-segment elevation myocardial infarction (STEMI), occupy the first rank of hospitalization cause in Cardio Vascular Care Unit (CVCU). STEMI is associated with serious conditions and complications that affect length of stay (LOS). Assessing clinical outcomes is required as a foundation for quality improvement. LOS is a clinical parameter for health care efficiency. Shorter LOS allows for improved patient-centered care, improved health outcome, and lower readmission rates.
The aim of this study is to assess factors that can predict the LOS prolongation in STEMI patients in Sardjito General Hospital.
Methods: We performed cross sectional study from Sardjito Cardiovascular Intensive Care (SCIENCE) registry and Acute Coronary Syndrome (ACS) registry, consists of STEMI patients from January through October 2017. We analyse demographic baseline, coronary risk factor, comorbidities, reperfusion therapy, echocardiographic findings, and laboratory parameter to know which factor could possibly be predictor for prolongation of LOS. LOS prolongation was define as hospitalization > 5 days due to clinical pathway of STEMI patients in Sardjito General Hospital.
Results: From 297 patients with mean age 60.45 ± 12.20 years old, mean LOS was 7.28 ± 3.96 days. Arrhythmia malignant was shown to increase the relative risk of prolonged LOS in CVCU patients by 1.52 (95% CI:1.02-2.26; p=0.035). On the other hand, reperfusion either by fibrinolytic or mechanical was shown to reduce the relative risk of prolonged LOS in the same setting by 0.85 (95% CI:0.74-0.96; p=0.024). After multivariate analysis, only reperfusion that became independent predictor for prolonged LOS (OR 2.162, 95% CI:1.17- 4.0; p=0.014)
Conclussion: In this study we found reperfusion therapy becomes an independent predictor for LOS prolongation in STEMI patients. Reperfusion therapy hold important factor to reduce the LOS in the CVCU patients.
KEYWORDS : Predictor, length of stay, STEMI, Reperfusion therapy
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