Abstract 13057: Efficient Diagnosis and Reduced Medical Costs by the 0-hour/1-hour Algorithm for Patients With Suspected Non ST Elevation Acute Myocardial Infarction in the Emergency Department

Abstract

Background: European Society Cardiology guidelines recommend that the 0-hour/1-hour (0-1h) algorithm using high sensitivity cardiac troponin T (hs-cTnT) improves the early triage of patients with chest pain. To avoid the unnecessary admission including coronary angiography leads to decrease in medical costs. However, the economic consequences of applying the algorithm are unknown. Purpose: We compared the medical expenses to be affected by the implementation of this algorithm. Methods: We compared two prospective cohort study (one hospital has been implemented the 0-1h algorithm (cohort A), and the other has not (cohort B)) using a de-identified electronic medical record based on the database of health claims in Japan. Eligible patients were measured of hs-cTnT because of chest pain. We excluded patients with STEMI, heart failure or terminal kidney function. The 0-1h algorithm stratified patients into “rule-out,” “rule-in,” and “observation” based on the measurements of hs-cTnT levels at baseline and absolute changes at 1hour. Resource utilization (RU) and predicted diagnostic accuracy of the 0-1h algorithm compared to usual care in the emergency department (ED) were estimated. We then assumed that we implemented the 0-1h algorithm in cohort B by applying the diagnostic accuracy of the 0-1h algorithm to cohort B and compared it with the collected data achieved within 30 days of the index visit. Results: Consecutive 472 in cohort A (69.6 +/- 14.1 years old, 59.5% male) and 427 in cohort B (65.8 +/- 14.4 years old, 59.0% male) were followed. The prevalence rates of AMI were 7.4% and 3.3%. The sensitivity and specificity for the 0-1h algorithm in cohort A were 100% (91.1%-100%) and 95.0% (94.3%-95.0%), compared to 92.9% (69.6%-98.7%) and 89.8% (89.0%-90.0%) for usual care in cohort B. Assuming that the 0-1 algorithm is implemented in cohort B with the same diagnostic accuracy, emergency CAG is expected to be reduced by 50%, with a reduction in healthcare costs of approximately $ 1,500 to $ 2,500 per person. As a result, the implementation of the 0-1hr algorithm is expected to reduce medical costs by $ 31,500 to $ 52,500 in cohort B. Conclusions: The 0-1h algorithm dose not only efficiently stratifies risks, but can also be expected to reduce medical costs.