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Cost and outcomes of assessing patients with chest pain in an Australian emergency department

Louise Cullen, Jaimi Greenslade, Katharina Merollini, Nicholas Graves, Christopher J K Hammett, Tracey Hawkins, Martin P Than, Anthony F T Brown, Christopher B Huang, Seyed E Panahi, Emily Dalton and William A Parsonage
Med J Aust 2015; 202 (8): 427-432. || doi: 10.5694/mja14.00472

Summary

Objectives: We sought to characterise the demographics, length of admission, final diagnoses, long-term outcome and costs associated with the population who presented to an Australian emergency department (ED) with symptoms of possible acute coronary syndrome (ACS).

Design, setting and participants: Prospectively collected data on ED patients presenting with suspected ACS between November 2008 and February 2011 was used, including data on presentation and at 30 days after presentation. Information on patient disposition, length of stay and costs incurred was extracted from hospital administration records.

Main outcome measures: Primary outcomes were mean and median cost and length of hospital stay. Secondary outcomes were diagnosis of ACS, other cardiovascular conditions or non-cardiovascular conditions within 30 days of presentation.

Results: An ACS was diagnosed in 103 (11.1%) of the 926 patients recruited. 193 patients (20.8%) were diagnosed with other cardiovascular-related conditions and 622 patients (67.2%) had non-cardiac-related chest pain. ACS events occurred in 0 and 11 (1.9%) of the low-risk and intermediate-risk groups, respectively. Ninety-two (28.0%) of the 329 high-risk patients had an ACS event. Patients with a proven ACS, high-grade atrioventricular block, pulmonary embolism and other respiratory conditions had the longest length of stay. The mean cost was highest in the ACS group ($13 509; 95% CI, $11 794–$15 223) followed by other cardiovascular conditions ($7283; 95% CI, $6152–$8415) and non-cardiovascular conditions ($3331; 95% CI, $2976–$3685).

Conclusions: Most ED patients with symptoms of possible ACS do not have a cardiac cause for their presentation. The current guideline-based process of assessment is lengthy, costly and consumes significant resources. Investigation of strategies to shorten this process or reduce the need for objective cardiac testing in patients at intermediate risk according to the National Heart Foundation and Cardiac Society of Australia and New Zealand guideline is required.

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  • Louise Cullen1
  • Jaimi Greenslade2
  • Katharina Merollini2
  • Nicholas Graves2
  • Christopher J K Hammett1
  • Tracey Hawkins1
  • Martin P Than3
  • Anthony F T Brown1
  • Christopher B Huang4
  • Seyed E Panahi4
  • Emily Dalton1
  • William A Parsonage1

  • 1 Royal Brisbane and Women's Hospital, Brisbane, QLD.
  • 2 Queensland University of Technology, Brisbane, QLD.
  • 3 Christchurch Hospital, Christchurch, New Zealand.
  • 4 University of Queensland, Brisbane, QLD.


Acknowledgements: 

This study was supported by a research grant from the Queensland Emergency Medical Research Foundation. We thank the Australian Institute of Health and Welfare for providing death registry data. We thank the patients who participated in the study and thank the research staff, emergency department staff and laboratory technicians of all participating sites for their invaluable efforts.

Competing interests:

While some of the authors have been in receipt of funding from different commercial sources, at no time has there been any external influence on the study design, data collection, data analysis, data interpretation, writing of the report or decision to submit the article.

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