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

Cullen, Louise, Greenslade, Jaimi, Merollini, Katharina, Graves, Nicholas, Hammett, Christopher J. K., Hawkins, Tracey, Than, Martin P., Brown, Anthony F. T., Huang, Christopher B., Panahi, Seyed E., Dalton, Emily and Parsonage, William A. (2015) Cost and outcomes of assessing patients with chest pain in an Australian emergency department. Medical Journal of Australia, 202 8: 427-432. doi:10.5694/mja14.00472

Author Cullen, Louise
Greenslade, Jaimi
Merollini, Katharina
Graves, Nicholas
Hammett, Christopher J. K.
Hawkins, Tracey
Than, Martin P.
Brown, Anthony F. T.
Huang, Christopher B.
Panahi, Seyed E.
Dalton, Emily
Parsonage, William A.
Title Cost and outcomes of assessing patients with chest pain in an Australian emergency department
Journal name Medical Journal of Australia   Check publisher's open access policy
ISSN 1326-5377
Publication date 2015-05-04
Year available 2015
Sub-type Article (original research)
DOI 10.5694/mja14.00472
Open Access Status Not yet assessed
Volume 202
Issue 8
Start page 427
End page 432
Total pages 6
Place of publication Strawberry Hills, New South Wales, Australia
Publisher Australasian Medical Publishing
Language eng
Subject 2700 Medicine
Formatted abstract
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.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
School of Medicine Publications
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