Dominique N van Dongen1, Jan Paul Ottervanger2, Rudolf Tolsma3, Marion Fokkert4, Aize van der Sluis5, Arnoud W J van 't Hof6,7, Erik Badings5, Robbert J Slingerland4. 1. Department of Cardiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands. d.n.van.dongen@isala.nl. 2. Department of Cardiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands. 3. Regional Ambulance Service IJsselland, Zwolle, The Netherlands. 4. Department of Clinical Chemistry, Isala Hospital, Zwolle, The Netherlands. 5. Department of Cardiology, Deventer Hospital, Deventer, The Netherlands. 6. Zuyderland MC, Heerlen, The Netherlands. 7. Department of Cardiology, MUMC, Maastricht, The Netherlands.
Abstract
BACKGROUND: There is increasing evidence that in patients presenting with acute chest pain, pre-hospital triage can accurately identify low-risk patients. It is, however, still unclear which diagnostics are performed in pre-hospital-adjudicated low-risk patients and what the contribution is of those diagnostic results in the healthcare process. OBJECTIVES: The aim of this study was to quantify healthcare utilization, costs, and outcomes in pre-hospital-adjudicated low-risk chest-pain patients, and to extrapolate to total costs in the Netherlands. METHODS: This was a prospective cohort study including 700 patients with suspected non-ST-elevation acute coronary syndrome in which pre-hospital risk stratification using the HEART score was performed by paramedics. Low risk was defined as a pre-hospital HEART score ≤ 3. Data on (results of) hospital diagnostics, costs, and discharge diagnosis were collected. RESULTS: A total of 172 (25%) patients were considered as low risk. Of these low-risk patients, the mean age was 54 years, 52% were male, and 84% of patients were discharged within 12 h. Repeated electrocardiography and routine laboratory measurements, including cardiac markers, were performed in all patients. Chest X-ray was performed in 61% and echocardiography in 11% of patients. After additional diagnostics, two patients (1.2%) were diagnosed as non-ST-elevation myocardial infarction and two patients (1.2%) as unstable angina. Other diagnoses were atrial fibrillation (n = 1) and acute pancreatitis/cholecystitis (n = 2); all other patients had non-specific/non-acute discharge diagnoses. Mean in-hospital costs per patient were €1580. The estimated yearly acute healthcare cost in low-risk chest-pain patients in the Netherlands is €30,438,700. CONCLUSION: In low-risk chest-pain patients according to pre-hospital risk assessment, acute healthcare utilization and costs are high, with limited added value. Possibly, if a complete risk assessment can be performed by ambulance paramedics, acute hospitalization of the majority of low-risk patients is not necessary, which can lead to substantial cost reduction. TRIAL ID: Dutch Trial Register [http://www.trialregister.nl]: trial number 4205.
BACKGROUND: There is increasing evidence that in patients presenting with acute chest pain, pre-hospital triage can accurately identify low-risk patients. It is, however, still unclear which diagnostics are performed in pre-hospital-adjudicated low-risk patients and what the contribution is of those diagnostic results in the healthcare process. OBJECTIVES: The aim of this study was to quantify healthcare utilization, costs, and outcomes in pre-hospital-adjudicated low-risk chest-painpatients, and to extrapolate to total costs in the Netherlands. METHODS: This was a prospective cohort study including 700 patients with suspected non-ST-elevation acute coronary syndrome in which pre-hospital risk stratification using the HEART score was performed by paramedics. Low risk was defined as a pre-hospital HEART score ≤ 3. Data on (results of) hospital diagnostics, costs, and discharge diagnosis were collected. RESULTS: A total of 172 (25%) patients were considered as low risk. Of these low-risk patients, the mean age was 54 years, 52% were male, and 84% of patients were discharged within 12 h. Repeated electrocardiography and routine laboratory measurements, including cardiac markers, were performed in all patients. Chest X-ray was performed in 61% and echocardiography in 11% of patients. After additional diagnostics, two patients (1.2%) were diagnosed as non-ST-elevation myocardial infarction and two patients (1.2%) as unstable angina. Other diagnoses were atrial fibrillation (n = 1) and acute pancreatitis/cholecystitis (n = 2); all other patients had non-specific/non-acute discharge diagnoses. Mean in-hospital costs per patient were €1580. The estimated yearly acute healthcare cost in low-risk chest-painpatients in the Netherlands is €30,438,700. CONCLUSION: In low-risk chest-painpatients according to pre-hospital risk assessment, acute healthcare utilization and costs are high, with limited added value. Possibly, if a complete risk assessment can be performed by ambulance paramedics, acute hospitalization of the majority of low-risk patients is not necessary, which can lead to substantial cost reduction. TRIAL ID: Dutch Trial Register [http://www.trialregister.nl]: trial number 4205.
Authors: Tonje R Johannessen; Sigrun Halvorsen; Dan Atar; John Munkhaugen; Anne Kathrine Nore; Torbjørn Wisløff; Odd Martin Vallersnes Journal: BMC Health Serv Res Date: 2022-10-21 Impact factor: 2.908
Authors: Goaris W A Aarts; Cyril Camaro; Robert-Jan van Geuns; Etienne Cramer; Roland R J van Kimmenade; P Damman; Pierre M van Grunsven; Eddy Adang; Paul Giesen; Martijn Rutten; Olaf Ouwendijk; Marc E R Gomes; Niels van Royen Journal: BMJ Open Date: 2020-02-17 Impact factor: 2.692
Authors: Tonje R Johannessen; Dan Atar; Odd Martin Vallersnes; Anne Cecilie K Larstorp; Ibrahimu Mdala; Sigrun Halvorsen Journal: BMJ Open Date: 2021-02-24 Impact factor: 2.692