“Did you know the most common serious underlying causes for the symptom of chest pain are acute coronary syndromes (ACS), incorporating acute myocardial infarction and unstable angina pectoris? The enclosed research article is Australian and was published in the Medical Journal of Australia in May 2015 identifies the cost per event which is interesting.
“Patients with chest pain make up a large proportion of Emergency Department (ED) visitors. This study looked at characterise the demographics, length of hospital stay (LOS), final diagnoses, long-term outcome and costs associated with the population who presented to an Australian ED with symptoms of possible acute coronary syndrome (ACS). Consistent with other studies, the final proportion of chest pain patients with a diagnosis of ACS was 11.1%, with 20.8% of patients having other cardiovascular causes diagnosed. Non-cardiac chest pain was diagnosed in 622 (67.2%) of the 926 patients.
Current guidelines categorise patients with suspected ACS as high, intermediate and low risk. In this study, the high-risk group incurred the highest cost per patient, but also had the highest rate of ACS events. In contrast, the intermediate-risk group was the most resource-intensive, yet these costs were expended to diagnose a very small proportion (1.9%) of patients with ACS. The overall costs per event in the intermediate group were high ($174 191 per ACS event). The authors acknowledge that intermediate risk patients cannot currently be discharged unless their risk of an ACS event can be better categorised. Accelerated diagnostic protocols have been tested in clinical trials by Cullen and others, however these are not currently accepted practice. The authors argue that “investigation of strategies to shorten this process or safely reduce the need for objective cardiac testing in patients at intermediate risk according to the NHF/CSANZ guidelines is required.“