Author + information
- Sanket Gokhale,
- Binnie Desai,
- Aamir Twing and
- Adhir Ramesh Shroff
The VA Mission Act of 2018 sought to increase access to local care facilities for Veterans meeting certain eligibility criteria including residing greater than 40 miles from a VA facility. As part of an ongoing review of our VA program’s same day discharge (SDD) program following elective PCI, we investigated whether the distance criteria of the VA Mission Act had any impact on overall safety outcomes.
We performed a single center, retrospective study in patients who underwent outpatient PCI between January 1, 2013 and August 30, 2019. We stratified patients into an overnight observation (ON) and SDD group and matched them in a 2:1 fashion. Patients stratified to the SDD group met all inclusion and exclusion criteria to be eligible for same-day discharge. We used Google Maps in order to calculate patient home distance to the Jesse Brown VA (JBVA) in Chicago, Illinois. Primary endpoints included all-cause death and MACE (CV death, MI, stroke, and/or target vessel revascularization). Secondary outcomes included total unplanned interactions with the healthcare system (ED visits/urgent care visits/hospital admissions), bleeding events, AKI, CHF exacerbations, and post-PCI complications. Outcomes were analyzed at 30 days after the procedure. T and Chi square tests were used to analyze continuous/categorical variables.
We included 219 patients in the study with 73 stratified into the SDD group. Demographics for the SDD group included a mean distance from the JBVA of 107.7 miles and a mean age of 64.1 years. Additionally, 97.2% were male and 42.4% were black. Radial access was used for all SDD patients. Regarding primary outcomes, we did not observe a statistically significant difference in terms of all-cause mortality at 30 days (ON: 1.3%, SDD: 0%, p=0.315). Additionally, there was no significant difference with regards to MACE at 30 days following PCI (ON: 0.68%, SDD: 0%, p=0.478). All secondary outcomes at 30 days did not demonstrate a statistically significant difference between either group (p>0.05).
Same day discharge following successful PCI procedures appears safe. In response to the VA Mission Act, distance did not impact outcomes.
Posters Hall_Hall A
Saturday, March 28, 2020, 12:30 p.m.-1:15 p.m.
Session Title: Spotlight on Special Topics: Shared Decision Making 2
Abstract Category: 45. Spotlight on Special Topics: Shared Decision Making
Presentation Number: 1172-268
- 2020 American College of Cardiology Foundation