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Early identification of patients at low risk of death after myocardial infarction and potentially suitable for early hospital discharge

Department of Public Health, University of Western Australia, Nedlands 6009, Perth, Western Australia Department of Cardiovascular Medicine, Queen Elizabeth II Medical Centre, Nedlands 6009, Perth, Western Australia Correspondence to: Dr Parsons.

Abstract

Objectives : To find (a) whether data available shortly after admission for acute myocardial infarction can provide a reliable prognostic indicator of survival at 28 days, and (b) whether such an indicator might be used to identify patients at low risk of death and suitable for early discharge.
Design : Retrospective analysis of data collected on patients admitted to a coronary care unit for acute myocardial infarction. A validation sample was selected at random from these patients.
Setting : Coronary care units in Perth, Western Australia.
Subjects : 6746 patients aged under 65 and resident in the Perth Statistical Division who during 1984-92 were admitted to a coronary care unit with symptoms of myocardial infarction.
Main outcome measures : Sensitivity and specificity of several models for predicting survival at 28 days after myocardial infarction, and detailed performance characteristics of a particular model.
Results : Patients with a pulse rate of 100 beats/min or less, aged 60 or under, and with symptoms typical of myocardial infarction, no past history of myocardial infarction or diabetes, and no significant Q wave in the admission electrocardiogram had a very high chance of survival at 28 days (99.2%). These patients made up one third of all patients studied.
Conclusion : The prognostic index identifies patients very soon after admission who are at low risk of death and potentially eligible for early discharge from hospital or the coronary care unit. Computing the index does not need complex cardiac investigations.

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