Left Ventricular Evaluation in ACS Patients: Impact in Patient Discharge and Outcomes

Abstract

Inpatient LV assessment post ACS is a recommended practice in most guidelines. In a busy hospital, performing an inpatient echocardiography may delay patient discharge. Aim:1)Does awaiting inpatient echocardiography in NSTE-ACS patients have any impact on discharge timing?2)When LV assessment is planned as an outpatient or not performed at all does it have an adverse outcome? Method: Patients admitted with NSTEACS over a 6month period to Waikato hospital were included. There were 3 cohorts: inpatient LV assessment, planned outpatient LV assessment and no LV assessment post index admission. Data was collected from ACSQI website and electronic hospital database Results: Of 297 patents admitted with ACS 182 were identified as NSTEACS. The mean follow-up was 238 days, which was similar in all 3 cohorts. Out of 119 patients who had inpatients LV assessment 3.3% (4pts) encountered a delayed discharge. 11% were readmitted with a cardiac event. Planned out patient echocardiography was done only in 14% at the recommended time frame of 3 months in whom no cardiac events were noted. 21%(3 of 14) of patients who were waiting outpatient echocardiography had a cardiac event needing readmission. Out of 63 patients with no LV assessment planned at discharge 35% (17pt) suffered a cardiac event. In spite of high readmission rates, <2% were admitted due to heart failure which might have been altered by a LV assessment. Conclusion: It appears readmission due to cardiac events post NSTEACS is reduced by a timely LV assessment without significant delays in discharge. However from this study it is uncertain performing a LV assessment could have prevented these readmissions.