Declining length of hospital stay for acute myocardial infarction and postdischarge outcomes: a community-wide perspective.

BACKGROUND The objectives of this population-based study were to describe trends of more than a decade (1986-1999) in duration of hospitalization after acute myocardial infarction (AMI), patient characteristics associated with varying lengths of stay, and the impact of declining length of stay on postdischarge mortality. METHODS The study sample consisted of 4551 patients discharged after AMI from all greater Worcester, Mass, hospitals in 8 annual periods during the study period. Regression models were used to examine the influence of demographic, clinical, and treatment variables on length of stay and the association between declining length of hospital stay and postdischarge mortality. RESULTS Marked declines were observed in the average length of stay between the 1986-1988 (11.7 days) and 1997-1999 (5.9 days) periods. Factors associated with a longer hospital stay included advanced age, female sex, anterior and Q-wave MI, and occurrence of clinically important cardiac complications. Patients with health maintenance organization, Medicare, Medicaid, or no insurance coverage were less likely to have an increased length of stay. Increased 30- and 90-day mortality was associated with a length of stay of greater than 14 days (odds ratio, 2.08; 95% confidence interval, 1.18-3.66) relative to those with a length of stay of 6 to 8 days (odds ratio, 2.01; 95% confidence interval, 1.34-3.01). Patients with a length of stay of less than 6 days exhibited no significant increases in postdischarge mortality. Similar trends were observed in patients with a complicated AMI. CONCLUSIONS We found marked decreases in length of stay for patients hospitalized with AMI during the past decade. However, we found no negative association between declining length of stay and short-term mortality after hospital discharge for AMI.