P5247In-hospital healthcare utilization, outcomes and costs in pre-hospital adjudicated low-risk chest pain patients

Abstract

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, yet 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 is to quantify health care utilization, costs and outcomes in pre-hospital adjudicated low-risk chest pain patients, and to extrapolate to costs on a national level. Methods This is a prospective cohort study including 700 patients with suspected NSTE-ACS 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, mean age was 54 years, 52% were male, 84% of patients were discharged within 12 hours. Repeated electrocardiography and routine laboratory measurements, including cardiac markers were performed in all patients. Chest X-ray was performed in 61%, echocardiography in 11% of patients. After additional diagnostics, 2 patients (%) were diagnosed as non-STEMI, 2 patients (%) 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 €1.580,-. The estimated yearly acute healthcare costs in low-risk chest pain patients in the Netherlands are € 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.