(P156) IDENTIFYING SOCIAL FACTORS THAT MAY LIMIT EARLY DISCHARGE IN LOW-RISK ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION

Background: The implementation of the Zwolle Risk Score (ZRS) has been shown to effectively triage patients based on clinical and angiographic parameters to coronary care unit (high risk) or the general telemetry ward (low risk) following percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). With the utilization of early discharge pathways in low-risk STEMI, patients have been safely discharged within 48 hours. Growing concerns of resource scarcity have compelled a local interest in the development of an early discharge protocol in patients with minimal comorbidities and suitable social circumstances. This study aimed to determine the proportions of low-risk STEMI patients with favorable and unfavorable social parameters for early discharge.

METHODS AND RESULTS: From an existing provincial database, all STEMI patients from November 2019 to July 2020 were reviewed (n=452) and 59% were low-risk STEMI defined as ZRS ≤3 (n=268). We excluded patients with incomplete social data (n=42) or ICU-level complications or in-hospital events (n=23). The composite outcome of 30-day mortality, recurrent MI, repeat PCI, stroke, and hospitalization occurred in 11 (5.4%) patients. Of the remaining 203 analyzed, the median age was 61 years (IQR 55-71), 26% were female, 14% had previous PCI, 2% had previous CABG, and the median ZRS was 2. From review of individual social variables, patients were analyzed in 2 groups: favorable (n=111, 55%) and unfavorable (n=92, 45%) for potential early discharge (see Table for definitions). Of the patients that were unfavorable for early discharge, the most common reason was rural location (n=66, 72%). Additionally, 41% of patients had more than 1 unfavorable factor. Approximately 7.9% of patients were unemployed and 18% lived in a group home, assisted living or supportive housing. No patients were wheelchair or bedbound and barriers to effective communication were identified in 4.5%. New home care start occurred in 1 patient and four additional patients required daily homecare for medication administration. Seven patients (3.4%) received financial assistance. On admission, 8.4% of patients self-identified concerns regarding discharge and 9.0% of patients did not demonstrate a good understanding of their condition or medications.

Conclusion: In low-risk STEMI defined as ZRS ≤3, almost half (45%) are not suitable for early discharge due to social factors. This limits the applicability of an early discharge program in reducing resource utilization.