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Emerging Concepts and Designing Effectiveness Research in the Process of Care of Patients Hospitalized with an Uncomplicated Acute Coronary Syndrome

Baris Gencer, François Girardin, Philippe Sigaud, Philippe Meyer, Marco Roffi, Stéphane Noble and François Mach

Background: Clinical researchers are major actors in translating evidence-based medicine into the care of patients. Acute Coronary Syndrome (ACS) is a good example for the implementation of complex intervention in the current context of growing economic pressure. According to the 2012 European Society of Cardiology guidelines, early discharge (approximately 72 hours of hospitalization) is reasonable in selected low-risk patients hospitalized with STEMI (ST-elevation myocardial infarction), if early rehabilitation is arranged. However, early discharge is not widely applied in clinical practice, and the potential barriers to shorten LOS have not been studied for patients hospitalized with an ACS.
Method: We will prospectively enroll 200 patients hospitalized with an ACS at the Geneva University Hospital using a before (100 patients, 2012-2013) and after (100 patients, 2013-2014) prospective cohort design. We will implement a systematic intervention consisting of four steps: (1) identification of low-risk patients treated successfully with percutaneous intervention using the Zwolle index Score; (2) targeting promptly an early discharge date within 72 hours after admission; (3) definition of a standard process of care during the hospital stay and (4) referral to a cardiac rehabilitation program within 10 days.
As primary outcome, we will assess the evolution of LOS using administrative data.
As secondary outcomes, we will analyze the potential barriers to an early discharge, the indicators of quality of care and the cost benefits comparing both periods before and after the implementation of an early discharge strategy. We will also assess the safety with a phone call at 30-day.
Summary: In the area of increase concerns on the long-term sustainability of the current health system,
translational science focusing on clinical effectiveness is more than needed. The systematic application of evidencebased recommendation is a way to improve the efficiency of process of care, as well as the transition from inpatient to outpatient setting.