In-Hospital Healthcare Utilization, Outcomes, and Costs in Pre-Hospital-Adjudicated Low-Risk Chest-Pain Patients

Dominique N. Dongen (), Jan Paul Ottervanger, Rudolf Tolsma, Marion Fokkert, Aize Sluis, Arnoud W. J. ‘t Hof, Erik Badings and Robbert J. Slingerland
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Dominique N. Dongen: Isala Hospital
Jan Paul Ottervanger: Isala Hospital
Rudolf Tolsma: Regional Ambulance Service IJsselland
Marion Fokkert: Isala Hospital
Aize Sluis: Deventer Hospital
Arnoud W. J. ‘t Hof: Zuyderland MC
Erik Badings: Deventer Hospital
Robbert J. Slingerland: Isala Hospital

Applied Health Economics and Health Policy, 2019, vol. 17, issue 6, No 11, 875-882

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, still 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 was to quantify healthcare utilization, costs, and outcomes in pre-hospital-adjudicated low-risk chest-pain patients, and to extrapolate to total costs in the Netherlands. Methods This was a prospective cohort study including 700 patients with suspected non-ST-elevation acute coronary syndrome 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, the mean age was 54 years, 52% were male, and 84% of patients were discharged within 12 h. Repeated electrocardiography and routine laboratory measurements, including cardiac markers, were performed in all patients. Chest X-ray was performed in 61% and echocardiography in 11% of patients. After additional diagnostics, two patients (1.2%) were diagnosed as non-ST-elevation myocardial infarction and two patients (1.2%) 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 €1580. The estimated yearly acute healthcare cost in low-risk chest-pain patients in the Netherlands is €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. Trial ID Dutch Trial Register [http://www.trialregister.nl]: trial number 4205.

Date: 2019
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DOI: 10.1007/s40258-019-00502-6

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