Value Based STEMI Care Using Risk-Guided Triage and Early Discharge

BACKGROUND: Prior studies suggest low-risk STEMI patients undergoing primary PCI can be considered for early discharge. We describe the implementation of a STEMI risk score to decrease cost while maintaining optimal patient outcomes. METHODS AND RESULTS: We determined the impact of risk-guided STEMI care on healthcare value through the retrospective application of the Zwolle Risk Score to 967 patients receiving primary PCI between 2009 and 2011. Of these patients, 540 (56%) were categorized as low-risk, indicating they may be safely triaged directly to a telemetry unit, rather than the intensive care unit and targeted for early discharge. We subsequently developed and implemented a modified Zwolle Risk Calculator into the electronic medical record to support application of the fast-track protocol for low-risk STEMI patients. Among 549 prospective STEMI patients, 62% were low-risk and the fast-track protocol was followed in 75% of cases. Prospective results confirmed lower rates of complications (low-risk 8.3% vs. high-risk 38.7%; p