Abstract
Background
Non-cardiac aetiologies are common among patients presenting with chest pain.
Aim
To determine the cost of non-specific chest pain admissions to a tertiary referral, teaching hospital.
Methods
Thrombolysis in myocardial infarction risk (TIMI) risk score, lengths of stay (LOS), investigations and diagnoses were recorded for patients admitted with chest pain. Non-specific chest pain was defined as chest pain where cardiac, pulmonary and gastroesophageal aetiologies were excluded. Costs of admissions were calculated.
Results
Of 80 patients, 34 (43 %) and 22 (28 %) were diagnosed with non-specific chest pain and acute coronary syndrome, respectively. Non-specific chest pain admissions had a mean age of 54 (11; 35–74) years, LOS of 3.8 (2.6; 1–11) days and TIMI risk score of 1.4 (1.5; 0–5). Acute coronary syndrome admissions had a mean age of 67 (14; 43–94) years, LOS of 7.7 (4.3; 2–16) days and TIMI risk score of 3.1 (1.2; 0–5). The mean cost per non-specific chest pain admission was €3,729 (2,378; 1,034–10,468), or 48 % of the mean cost per acute coronary syndrome admission of €7,667 (4,279; 1,963–16,071). Bed day costs account for >90 % of overall costs. Only 7 % of patients were weekend discharges. The mean interval to exercise stress test was 2.7(1.5; 1–7) days.
Conclusions
The mean costs of admission and LOS for patients with non-specific chest pain are significant. Extrapolating findings, annual national cost is estimated at approximately €71 million for this cohort, with 73,000 bed days consumed nationally. Delays from admission to tests and low percentage of weekend discharges prolong LOS
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References
Nawar EW, Niska RW, Xu J (2007) National hospital ambulatory medical care survey: 2005 emergency department summary. Adv Data 386:1–32
Cassin M, Badano LP, Solinas L et al (2000) Is a more efficient operative strategy feasible for the emergency management of the patient with acute chest pain? Ital Heart J Suppl 1:186–201
Graff LG, Dallara J, Ross MA et al (1997) Impact on the care of the emergency department chest pain patient from the chest pain evaluation registry (CHEPER) study. Am J Cardiol 80:563–568
Pope JH, Aufderheide TP, Ruthazer R et al (2000) Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med 342:1163–1170
NHS Institute for Innovation and Improvement (2007) Directory of emergency ambulatory care for adults. http://www.institute.nhs.uk/option,com_joomcart/Itemid,26/main_page,document_product_info/products_id,181.htm. Accessed 23 Oct 2011
Goodacre S, Cross E, Arnold J et al (2005) The health care burden of acute chest pain. Heart 91:229–230
Goodacre S, Cross E, Lewis C et al (2007) ESCAPE Research Team. Effectiveness and safety of chest pain assessment to prevent emergency admissions: ESCAPE cluster randomised trial. BMJ 335:659
Mitchell AM, Garvey JL, Chandra A et al (2006) Prospective multicenter study of quantitative pretest probability assessment to exclude acute coronary syndrome for patients evaluated in emergency department chest pain units. Ann Emerg Med 47:447
Cakir B, Blue K (2007) How to improve the management of chest pain: hospitalists and use of prediction rules. South Med J 100:242–247
Roberts RR, Zalenski RJ, Mensah EK et al (1997) Costs of an emergency department-based accelerated diagnostic protocol vs hospitalization in patients with chest pain: a randomized controlled trial. JAMA 278:1670–1676
Storrow AB, Gibler WB (2000) Chest pain centers: diagnosis of acute coronary syndromes. Ann Emerg Med 35:449–461
Fineberg HV, Scadden D, Goldman L (1984) Care of patients with a low probability of acute myocardial infarction. Cost effectiveness of alternatives to coronary-care-unit admission. N Engl J Med 310:1301–1307
Antman EM, Cohen M, Bernink PJ et al (2000) The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA 284:835–842
http://www.hse.ie/eng/about/PersonalPQ/PQ/2010_PQ_Responses/December_2010/Caoimhghin_O_Caolain_PQ_48039-10_pdf. Accessed 3 May 2011
Forberg JL, Henriksen LS, Edenbrandt L et al (2006) Direct hospital costs of chest pain patients attending the emergency department: a retrospective study. BMC Emerg Med 6:6
McCullough PA, Ayad O, O’Neill WW et al (1998) Costs and outcomes of patients admitted with chest pain and essentially normal electrocardiograms. Clin Cardiol 21:22–26
Harrell FE (1985) Regression models for prognostic prediction: advantages, problems, and suggested solutions. Cancer Treatment Reports 69, no. 10
Chan GW, Sites FD, Shofer FS et al (2003) Impact of stress testing on 30-day cardiovascular outcomes for low-risk patients with chest pain admitted to floor telemetry beds. Am J Emerg Med 21:282–287
Nichol G, Walls R, Goldman L et al (1997) A critical pathway for management of patients with acute chest pain who are at low risk for myocardial ischemia: recommendations and potential impact. Ann Intern Med 127:996–1005
Storrow AB, Gibler WB (2000) Chest pain centers: diagnosis of acute coronary syndromes. Ann Emerg Med 35:449–461
Graff LG, Dallara J, Ross MA et al (1997) Impact on the care of the emergency department chest pain patient from the chest pain evaluation registry (CHEPER) study. Am J Cardiol 80:563–568
Bholasingh R, de Winter RJ, Fischer JC et al (2001) Safe discharge from the cardiac emergency room with a rapid rule-out myocardial infarction protocol using serial CK-MB(mass). Heart 85:143–148
Fleischmann KE, Goldman L, Johnson PA et al (2002) Critical pathways for patients with acute chest pain at low risk. J Thromb Thrombolysis 13:89–96
Goodacre S, Nicholl J, Dixon S et al (2004) Randomised controlled trial and economic evaluation of a chest pain observation unit compared with routine care. BMJ 328:254–257
Roberts RR, Zalenski RJ, Mensah EK et al (1997) Costs of an emergency department-based accelerated diagnostic protocol vs hospitalization in patients with chest pain: a randomized controlled trial. JAMA 278:1670–1676
Krasuski RA, Hartley LH, Lee TH et al (1999) Weekend and holiday exercise testing in patients with chest pain. J Gen Intern Med 14:66–67
Nash IS, Nash DB, Fuster V (1997) Do cardiologists do it better? J Am Coll Cardiol 29:475–478
Weingarten SR, Lloyd L, Chiou CF et al (2002) Do subspecialists working outside of their specialty provide less efficient and lower-quality care to hospitalized patients than do primary care physicians? Arch Intern Med 162:527–532
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Groarke, J., O’Brien, J., Go, G. et al. Cost burden of non-specific chest pain admissions. Ir J Med Sci 182, 57–61 (2013). https://doi.org/10.1007/s11845-012-0826-5
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DOI: https://doi.org/10.1007/s11845-012-0826-5