Search

Background: Non-cardiac chest pain (NCCP) is a common complaint. Our aim was to present a detailed description of the costs of patients with NCCP compared to patients with acute myocardial infarction (AMI) and Angina Pectoris (AP) from a societal perspective., Methods: Data on healthcare utilization and annual societal costs, including direct healthcare costs and indirect costs due to productivity loss, were collected from different databases. The participants consisted of 199 patients from a general hospital in Sweden (99 with NCCP, 51 with AMI, 49 with AP), mean age of 67 years, 59% men., Results: NCCP, AMI, and AP patients had on average 54, 50 and 65 primary care contacts and 3, 4, and 4 hospital admissions during a period of 2 years. Length of hospital stay was 6, 11 and 11 days. On average, 14%, 18%, and 25% of NCCP, AMI and AP patients were on sick-leave annually, and about 12% in each group received a disability pension. The mean annual societal costs of NCCP, AMI and AP patients were €10,068, €15,989 and €14,737., Conclusions: Although the annual societal cost of NCCP patients was lower than in AMI and AP patients, the cost was still considerable (€10,068). Taken into account the high prevalence of NCCP, the cumulative annual national cost of these patients could be more than the double of AMI and AP if all patients incurred the same costs as in this study. Targeted interventions are important in order to support patients with NCCP and minimize healthcare utilization and costs.

Study Objective: We determined the additional cost of an extended emergency department (ED) length of stay for chest pain patients awaiting non-ICU, monitored (telemetry) beds., Methods: This was a prospective cohort study of all ED chest pain patients aged 24 years or older and admitted to a telemetry bed in an urban university hospital during a 12-month period. Structured ED data collection included demographics, chest pain presentation, medical history, and laboratory test and ECG results. Hospital course was monitored daily, followed by a 30-day telephone follow-up. Risk severity scores (Goldman, Acute Cardiac Ischemia-Time-Insensitive Predictive Instrument, and Charlson) were calculated. Hospital charges, real costs, and revenues were obtained at discharge and 2 years later. The main outcome measure was risk-adjusted additional cost to the hospital of a delayed ED admission. Clinical outcome was a secondary measure., Results: Of the 817 patients with chest pain presenting to the ED during the study period, there were 904 hospitalizations. Of these, 825 patients waited more than 3 hours for their bed (91%). There were 21 patient visits with a final diagnosis of acute myocardial infarction. ED length of stay was not associated with total hospital length of stay (r =0.01), hospital costs, or hospital or professional charges, revenues, or collection rates. The annual opportunity cost in lost hospital revenue for chest pain patients was 168,300 US dollars (204 US dollars per patient waiting >3 hours for a hospital bed)., Conclusion: Extended ED length of stay demonstrated no association with total hospital costs or revenues or total hospital length of stay but imposed substantial ED opportunity costs, with decreased potential revenue. Interventions that reduce ED delays in hospital admissions have the potential to significantly increase hospital revenues.

Recent advances in the treatment of acute coronary syndromes has raised awareness in the community that prompt presentation for chest pain may be life saving. Each year in the United States, more than 6 million people present to the hospital with an acute chest pain, making this the most common presenting chief complaint second only to abdominal pain. Most patients presenting with chest discomfort have a non-ischaemic electrocardiogram on presentation. However, these patients are routinely admitted to hospital due to diagnostic uncertainty for occult myocardial infarction or ischaemia. As an approach to this dilemma, many hospitals have created protocols as a means of facilitating the identification of infarction and ischaemia and the safe and effective triage of patients with a chief complaint of chest pain. Myocardial perfusion imaging at rest has been shown to be highly sensitive for the detection of acute myocardial infarction, and can be supplemented with provocative testing after infarction has been excluded. Diagnostic strategies that utilize myocardial perfusion imaging for the evaluation of acute chest pain have successfully improved the triage of these patients by avoiding inadvertent discharge of patients with myocardial infarctions, and reducing unnecessary hospital admissions and overall cost and expenditure.

The triage of patients presenting to the emergency department with chest pain and a normal or nondiagnostic ECG poses a significant diagnostic challenge to emergency physicians and cardiologists, leading to unnecessary hospital admissions and substantial associated costs. Radionuclide myocardial perfusion imaging can potentially play an important role in this setting, by providing both a safe and efficient means to risk stratify patients with a low-to-moderate likelihood of unstable angina. The proposed algorithm may serve as a strategy to improve utilization of hospital resources while safely identifying the subgroup of patients with acute chest discomfort who do not need to be admitted to the hospital.

More than 2 million patients are hospitalized annually in this country because of chest pain suggestive of myocardial ischemia. However, a coronary event is demonstrated in <20% of this population. It has been further shown that among patients presenting with acute chest pain, a very low-risk group, with <5% probability of a coronary event, can be identified by the initial clinical assessment. Recognition of this group could prevent many unnecessary hospital admissions, affording more appropriate patient care and improved cost-effectiveness. To enhance identification and management of low-risk patients with chest pain, several diagnostic approaches are currently being investigated to determine their value in the early detection of myocardial ischemia to select those requiring admission. In addition to the initial history, these strategies include physical examination and electrocardiogram, new serum markers, early noninvasive cardiac imaging by echocardiography or myocardial scintigraphy, new electrocardiographic methods, and early exercise testing. Most of these methods have shown promise for stratifying patients presenting with chest pain into high-risk and low-risk groups, thereby extending the initial clinical assessment in the critical decision of patient admission or discharge from the emergency department with early follow-up. This review presents the current status of these techniques with emphasis on our experience with immediate treadmill testing of selected patients in the emergency department. These methods are still in the developmental phase and their long-term utility will be determined by their safety, accuracy, cost, and specific institutional expertise.