Clinical Outcomes and Cost Effectiveness of Accelerated Diagnostic Protocol in a Chest Pain Center Compared with Routine Care of Patients with Chest Pain |
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| Authors: | Elad Asher Haim Reuveni Nir Shlomo Yariv Gerber Roy Beigel Michael Narodetski Michael Eldar Jacob Or Hanoch Hod Arie Shamiss Shlomi Matetzky |
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| Affiliation: | 1. Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.; 2. Ben Gurion University of the Negev, Soroka Medical Center, Beer Sheva, Israel.; 3. The School of Public Health, the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.; 4. Emergency Medicine Department, Sheba Medical Center, Tel Hashomer, Israel.; 5. Sheba Medical Center, Tel Hashomer, Israel.; University of Groningen, NETHERLANDS, |
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| Abstract: | AimsThe aim of this study was to compare in patients presenting with acute chest pain the clinical outcomes and cost-effectiveness of an accelerated diagnostic protocol utilizing contemporary technology in a chest pain unit versus routine care in an internal medicine department.Methods and ResultsHospital and 90-day course were prospectively studied in 585 consecutive low-moderate risk acute chest pain patients, of whom 304 were investigated in a designated chest pain center using a pre-specified accelerated diagnostic protocol, while 281 underwent routine care in an internal medicine ward. Hospitalization was longer in the routine care compared with the accelerated diagnostic protocol group (p<0.001). During hospitalization, 298 accelerated diagnostic protocol patients (98%) vs. 57 (20%) routine care patients underwent non-invasive testing, (p<0.001). Throughout the 90-day follow-up, diagnostic imaging testing was performed in 125 (44%) and 26 (9%) patients in the routine care and accelerated diagnostic protocol patients, respectively (p<0.001). Ultimately, most patients in both groups had non-invasive imaging testing. Accelerated diagnostic protocol patients compared with those receiving routine care was associated with a lower incidence of readmissions for chest pain [8 (3%) vs. 24 (9%), p<0.01], and acute coronary syndromes [1 (0.3%) vs. 9 (3.2%), p<0.01], during the follow-up period. The accelerated diagnostic protocol remained a predictor of lower acute coronary syndromes and readmissions after propensity score analysis [OR = 0.28 (CI 95% 0.14–0.59)]. Cost per patient was similar in both groups [($2510 vs. $2703 for the accelerated diagnostic protocol and routine care group, respectively, (p = 0.9)].ConclusionAn accelerated diagnostic protocol is clinically superior and as cost effective as routine in acute chest pain patients, and may save time and resources. |
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