Variation in ACS patient hospital resource utilization: Is it time for advanced NSTEMI risk stratification in the ED?

A majority of patients who experience acute coronary syndrome (ACS) initially receive care in the emergency department (ED). Guidelines for care of patients experiencing ACS, specifically ST-segment elevation myocardial infarction (STEMI) are well defined. We examine the utilization of hospital reso...

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Bibliographic Details
Published in:The American journal of emergency medicine 2023-08, Vol.70, p.171-174
Main Authors: Saxena, Monica, Bloos, Sean M., Graber-Naidich, Anna, Sundaram, Vandana, Pasao, Melissa, Yiadom, Maame Yaa A.B.
Format: Article
Language:English
Subjects:
ACS
Acute coronary syndromes
Angina
Angina pectoris
Authorship
Biomarkers
Cardiac catheterization
Cardiology
Cardiovascular disease
Emergency department
Emergency medical care
Heart attacks
Hospitalization
Hospitals
Intubation
Ischemia
Medical imaging
Mortality
Myocardial infarction
NSTEMI
Patients
Resource utilization
Risk factors
Software
Writing
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Summary:A majority of patients who experience acute coronary syndrome (ACS) initially receive care in the emergency department (ED). Guidelines for care of patients experiencing ACS, specifically ST-segment elevation myocardial infarction (STEMI) are well defined. We examine the utilization of hospital resources between patients with NSTEMI as compared to STEMI and unstable angina (UA). We then make the case that as NSTEMI patients are the majority of ACS cases, there is a great opportunity to risk stratify these patients in the emergency department. We examined hospital resource utilization measure between those with STEMI, NSTEMI, and UA. These included hospital length of stay (LOS), any intensive care unit (ICU) care time, and in-hospital mortality. The sample included 284,945 adult ED patients, of whom 1195 experienced ACS. Among the latter, 978 (70%) were diagnosed with NSTEMI, 225 (16%) with STEMI, and 194 with UA (14%). We observed 79.1% of STEMI patients receiving ICU care. 14.4% among NSTEMI patients, and 9.3% among UA patients. NSTEMI patients' mean hospital LOS was 3.7 days. This was shorter than that of non-ACS patients 4.75 days and UA patients 2.99. In-hospital mortality for NSTEMI was 1.6%, compared to, 4.4% for those with STEMI patients and 0% for UA. There are recommendations for risk stratification among NSTEMI patients to evaluate risk for major adverse cardiac events (MACE) that can be used in the ED to guide admission decisions and use of ICU care, thus optimizing care for a majority of ACS patients.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2023.05.028