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Actual Financial Comparison of Four Strategies to Evaluate Patients with Potential Acute Coronary Syndromes
Objectives: Small studies have shown that a negative computed tomography coronary angiogram (CTA) in low‐risk chest pain patients predicts a low rate of 30‐day adverse events. The authors hypothesized that an immediate CTA strategy would be as effective but less costly than alternative strategies f...
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| Published in: | Academic emergency medicine 2008-07, Vol.15 (7), p.649-655 |
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| container_title | Academic emergency medicine |
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| creator | Chang, Anna Marie Shofer, Frances S. Weiner, Mark G. Synnestvedt, Marie B. Litt, Harold I. Baxt, William G. Hollander, Judd E. |
| description | Objectives: Small studies have shown that a negative computed tomography coronary angiogram (CTA) in low‐risk chest pain patients predicts a low rate of 30‐day adverse events. The authors hypothesized that an immediate CTA strategy would be as effective but less costly than alternative strategies for evaluation of patients with potential acute coronary syndrome (ACS).
Methods: The authors retrospectively compared four strategies for evaluation of patients after initial physician determination that the patient required admission and testing to rule out ACS. Patients were frequency‐matched by age, race, gender, thrombolysis in myocardial infarction (TIMI) score, and initial electrocardiogram (ECG). The four groups were immediate CTA in the emergency department (ED) without serial markers (n = 98); clinical decision unit/observation unit (CDU) with biomarkers and CTA (n = 102); CDU evaluation with serial cardiac biomarkers and stress testing (n = 154); and usual care, defined as admission with serial biomarkers and hospitalist‐directed evaluation (n = 289). The main outcomes were actual cost of care (facility direct and indirect fixed, facility variable direct labor and supply costs), length of stay (LOS), diagnosis of coronary artery disease (CAD), and safety (30‐day death or myocardial infarction [MI]).
Results: Patients in each group were of similar age (mean ± standard deviation [SD] 46 ± 9 years), race (62% African American), and gender (57% female) and had similar TIMI scores (100% between 0–2). Comparing immediate CTA versus CDU CTA versus CDU stress versus usual care, median costs were less ($1,240 vs. 2,318 vs. 4,024 vs. 2,913; p |
| doi_str_mv | 10.1111/j.1553-2712.2008.00159.x |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_69872943</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>69872943</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4449-fe7996308be0482a45c9eb4912fb3e1861be617a1f3f085df04a9c197672b5cc3</originalsourceid><addsrcrecordid>eNqNUU1P3DAQtaqi8tH-hcrqobcEfyROfOCwinZbJBBIwNlyvE7rJYm3tlPYf99JdwUSJ3zxjObN05v3EMKU5BTe-SanZckzVlGWM0LqnBBayvz5Azp5GXyEmgiZiVLwY3Qa44YQUlay-oSOaS0kZZSfoMeFSZPu8cqNejQOqsYPWx1c9CP2HV75KeC7FHSyv5yNOHm8_Kv7CXp8q5OzY4r4yaXf-NYnaGaGhZlg2vjgRx12-G43roMfbPyMjjrdR_vl8J-hh9XyvvmZXd38uGwWV5kpikJmna2kFJzUrSVFzXRRGmnbAgR3LbcgnbZW0ErTjnekLtcdKbQ0VFaiYm1pDD9D3_e82-D_TDYmNbhobN_r0fopKiHrismCA_DbG-AGzh1Bm2KMgFWUCQDVe5AJPsZgO7UNboDDFCVqTkNt1Gy6mk1XcxrqfxrqGVa_HvindrDr18WD_QC42AOeXG937yZWi2Z5DRX_Byh2mK8</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>220797126</pqid></control><display><type>article</type><title>Actual Financial Comparison of Four Strategies to Evaluate Patients with Potential Acute Coronary Syndromes</title><source>Wiley-Blackwell Read & Publish Collection</source><creator>Chang, Anna Marie ; Shofer, Frances S. ; Weiner, Mark G. ; Synnestvedt, Marie B. ; Litt, Harold I. ; Baxt, William G. ; Hollander, Judd E.</creator><creatorcontrib>Chang, Anna Marie ; Shofer, Frances S. ; Weiner, Mark G. ; Synnestvedt, Marie B. ; Litt, Harold I. ; Baxt, William G. ; Hollander, Judd E.</creatorcontrib><description>Objectives: Small studies have shown that a negative computed tomography coronary angiogram (CTA) in low‐risk chest pain patients predicts a low rate of 30‐day adverse events. The authors hypothesized that an immediate CTA strategy would be as effective but less costly than alternative strategies for evaluation of patients with potential acute coronary syndrome (ACS).
Methods: The authors retrospectively compared four strategies for evaluation of patients after initial physician determination that the patient required admission and testing to rule out ACS. Patients were frequency‐matched by age, race, gender, thrombolysis in myocardial infarction (TIMI) score, and initial electrocardiogram (ECG). The four groups were immediate CTA in the emergency department (ED) without serial markers (n = 98); clinical decision unit/observation unit (CDU) with biomarkers and CTA (n = 102); CDU evaluation with serial cardiac biomarkers and stress testing (n = 154); and usual care, defined as admission with serial biomarkers and hospitalist‐directed evaluation (n = 289). The main outcomes were actual cost of care (facility direct and indirect fixed, facility variable direct labor and supply costs), length of stay (LOS), diagnosis of coronary artery disease (CAD), and safety (30‐day death or myocardial infarction [MI]).
Results: Patients in each group were of similar age (mean ± standard deviation [SD] 46 ± 9 years), race (62% African American), and gender (57% female) and had similar TIMI scores (100% between 0–2). Comparing immediate CTA versus CDU CTA versus CDU stress versus usual care, median costs were less ($1,240 vs. 2,318 vs. 4,024 vs. 2,913; p < 0.01), and LOS was shorter (8.1 hr vs. 20.9 hr vs. 26.2 hr vs. 30.2 hr; p < 0.01). Diagnosis of CAD was similar (5.1% vs. 5.9% vs. 5.8% vs. 6.6%; p = 0.95), but fewer patients had 30‐day death/MI (0% vs. 0% vs. 0.7% vs. 3.1%; p = 0.04) or 30‐day readmission (0% vs. 3.2% vs. 2.3% vs. 12.2%; p < 0.01).
Conclusions: Compared to the other strategies, immediate CTA was as safe, identified as many patients with CAD, had the lowest cost, had the shortest LOS, and allowed discharge for the majority of patients. Larger prospective studies should confirm safety before immediate CTA replaces other strategies to rule out possible ACS.
ACADEMIC EMERGENCY MEDICINE 2008; 15:649–655 © 2008 by the Society for Academic Emergency Medicine</description><identifier>ISSN: 1069-6563</identifier><identifier>EISSN: 1553-2712</identifier><identifier>DOI: 10.1111/j.1553-2712.2008.00159.x</identifier><identifier>PMID: 18691213</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>acute coronary syndrome ; Acute Coronary Syndrome - diagnostic imaging ; Acute coronary syndromes ; Biomarkers - analysis ; Chi-Square Distribution ; Comparative analysis ; computed tomography coronary angiography ; Coronary Angiography - economics ; cost analysis ; Costs and Cost Analysis - methods ; Electrocardiography ; Emergency medical care ; Female ; Heart attacks ; Humans ; Male ; Middle Aged ; observation unit ; Retrospective Studies ; Statistics, Nonparametric ; Tomography ; Tomography, X-Ray Computed - economics</subject><ispartof>Academic emergency medicine, 2008-07, Vol.15 (7), p.649-655</ispartof><rights>2008 by the Society for Academic Emergency Medicine</rights><rights>Copyright Hanley & Belfus, Inc. Jul 2008</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4449-fe7996308be0482a45c9eb4912fb3e1861be617a1f3f085df04a9c197672b5cc3</citedby><cites>FETCH-LOGICAL-c4449-fe7996308be0482a45c9eb4912fb3e1861be617a1f3f085df04a9c197672b5cc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18691213$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chang, Anna Marie</creatorcontrib><creatorcontrib>Shofer, Frances S.</creatorcontrib><creatorcontrib>Weiner, Mark G.</creatorcontrib><creatorcontrib>Synnestvedt, Marie B.</creatorcontrib><creatorcontrib>Litt, Harold I.</creatorcontrib><creatorcontrib>Baxt, William G.</creatorcontrib><creatorcontrib>Hollander, Judd E.</creatorcontrib><title>Actual Financial Comparison of Four Strategies to Evaluate Patients with Potential Acute Coronary Syndromes</title><title>Academic emergency medicine</title><addtitle>Acad Emerg Med</addtitle><description>Objectives: Small studies have shown that a negative computed tomography coronary angiogram (CTA) in low‐risk chest pain patients predicts a low rate of 30‐day adverse events. The authors hypothesized that an immediate CTA strategy would be as effective but less costly than alternative strategies for evaluation of patients with potential acute coronary syndrome (ACS).
Methods: The authors retrospectively compared four strategies for evaluation of patients after initial physician determination that the patient required admission and testing to rule out ACS. Patients were frequency‐matched by age, race, gender, thrombolysis in myocardial infarction (TIMI) score, and initial electrocardiogram (ECG). The four groups were immediate CTA in the emergency department (ED) without serial markers (n = 98); clinical decision unit/observation unit (CDU) with biomarkers and CTA (n = 102); CDU evaluation with serial cardiac biomarkers and stress testing (n = 154); and usual care, defined as admission with serial biomarkers and hospitalist‐directed evaluation (n = 289). The main outcomes were actual cost of care (facility direct and indirect fixed, facility variable direct labor and supply costs), length of stay (LOS), diagnosis of coronary artery disease (CAD), and safety (30‐day death or myocardial infarction [MI]).
Results: Patients in each group were of similar age (mean ± standard deviation [SD] 46 ± 9 years), race (62% African American), and gender (57% female) and had similar TIMI scores (100% between 0–2). Comparing immediate CTA versus CDU CTA versus CDU stress versus usual care, median costs were less ($1,240 vs. 2,318 vs. 4,024 vs. 2,913; p < 0.01), and LOS was shorter (8.1 hr vs. 20.9 hr vs. 26.2 hr vs. 30.2 hr; p < 0.01). Diagnosis of CAD was similar (5.1% vs. 5.9% vs. 5.8% vs. 6.6%; p = 0.95), but fewer patients had 30‐day death/MI (0% vs. 0% vs. 0.7% vs. 3.1%; p = 0.04) or 30‐day readmission (0% vs. 3.2% vs. 2.3% vs. 12.2%; p < 0.01).
Conclusions: Compared to the other strategies, immediate CTA was as safe, identified as many patients with CAD, had the lowest cost, had the shortest LOS, and allowed discharge for the majority of patients. Larger prospective studies should confirm safety before immediate CTA replaces other strategies to rule out possible ACS.
ACADEMIC EMERGENCY MEDICINE 2008; 15:649–655 © 2008 by the Society for Academic Emergency Medicine</description><subject>acute coronary syndrome</subject><subject>Acute Coronary Syndrome - diagnostic imaging</subject><subject>Acute coronary syndromes</subject><subject>Biomarkers - analysis</subject><subject>Chi-Square Distribution</subject><subject>Comparative analysis</subject><subject>computed tomography coronary angiography</subject><subject>Coronary Angiography - economics</subject><subject>cost analysis</subject><subject>Costs and Cost Analysis - methods</subject><subject>Electrocardiography</subject><subject>Emergency medical care</subject><subject>Female</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>observation unit</subject><subject>Retrospective Studies</subject><subject>Statistics, Nonparametric</subject><subject>Tomography</subject><subject>Tomography, X-Ray Computed - economics</subject><issn>1069-6563</issn><issn>1553-2712</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><recordid>eNqNUU1P3DAQtaqi8tH-hcrqobcEfyROfOCwinZbJBBIwNlyvE7rJYm3tlPYf99JdwUSJ3zxjObN05v3EMKU5BTe-SanZckzVlGWM0LqnBBayvz5Azp5GXyEmgiZiVLwY3Qa44YQUlay-oSOaS0kZZSfoMeFSZPu8cqNejQOqsYPWx1c9CP2HV75KeC7FHSyv5yNOHm8_Kv7CXp8q5OzY4r4yaXf-NYnaGaGhZlg2vjgRx12-G43roMfbPyMjjrdR_vl8J-hh9XyvvmZXd38uGwWV5kpikJmna2kFJzUrSVFzXRRGmnbAgR3LbcgnbZW0ErTjnekLtcdKbQ0VFaiYm1pDD9D3_e82-D_TDYmNbhobN_r0fopKiHrismCA_DbG-AGzh1Bm2KMgFWUCQDVe5AJPsZgO7UNboDDFCVqTkNt1Gy6mk1XcxrqfxrqGVa_HvindrDr18WD_QC42AOeXG937yZWi2Z5DRX_Byh2mK8</recordid><startdate>200807</startdate><enddate>200807</enddate><creator>Chang, Anna Marie</creator><creator>Shofer, Frances S.</creator><creator>Weiner, Mark G.</creator><creator>Synnestvedt, Marie B.</creator><creator>Litt, Harold I.</creator><creator>Baxt, William G.</creator><creator>Hollander, Judd E.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>200807</creationdate><title>Actual Financial Comparison of Four Strategies to Evaluate Patients with Potential Acute Coronary Syndromes</title><author>Chang, Anna Marie ; Shofer, Frances S. ; Weiner, Mark G. ; Synnestvedt, Marie B. ; Litt, Harold I. ; Baxt, William G. ; Hollander, Judd E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4449-fe7996308be0482a45c9eb4912fb3e1861be617a1f3f085df04a9c197672b5cc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>acute coronary syndrome</topic><topic>Acute Coronary Syndrome - diagnostic imaging</topic><topic>Acute coronary syndromes</topic><topic>Biomarkers - analysis</topic><topic>Chi-Square Distribution</topic><topic>Comparative analysis</topic><topic>computed tomography coronary angiography</topic><topic>Coronary Angiography - economics</topic><topic>cost analysis</topic><topic>Costs and Cost Analysis - methods</topic><topic>Electrocardiography</topic><topic>Emergency medical care</topic><topic>Female</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>observation unit</topic><topic>Retrospective Studies</topic><topic>Statistics, Nonparametric</topic><topic>Tomography</topic><topic>Tomography, X-Ray Computed - economics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chang, Anna Marie</creatorcontrib><creatorcontrib>Shofer, Frances S.</creatorcontrib><creatorcontrib>Weiner, Mark G.</creatorcontrib><creatorcontrib>Synnestvedt, Marie B.</creatorcontrib><creatorcontrib>Litt, Harold I.</creatorcontrib><creatorcontrib>Baxt, William G.</creatorcontrib><creatorcontrib>Hollander, Judd E.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Academic emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chang, Anna Marie</au><au>Shofer, Frances S.</au><au>Weiner, Mark G.</au><au>Synnestvedt, Marie B.</au><au>Litt, Harold I.</au><au>Baxt, William G.</au><au>Hollander, Judd E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Actual Financial Comparison of Four Strategies to Evaluate Patients with Potential Acute Coronary Syndromes</atitle><jtitle>Academic emergency medicine</jtitle><addtitle>Acad Emerg Med</addtitle><date>2008-07</date><risdate>2008</risdate><volume>15</volume><issue>7</issue><spage>649</spage><epage>655</epage><pages>649-655</pages><issn>1069-6563</issn><eissn>1553-2712</eissn><abstract>Objectives: Small studies have shown that a negative computed tomography coronary angiogram (CTA) in low‐risk chest pain patients predicts a low rate of 30‐day adverse events. The authors hypothesized that an immediate CTA strategy would be as effective but less costly than alternative strategies for evaluation of patients with potential acute coronary syndrome (ACS).
Methods: The authors retrospectively compared four strategies for evaluation of patients after initial physician determination that the patient required admission and testing to rule out ACS. Patients were frequency‐matched by age, race, gender, thrombolysis in myocardial infarction (TIMI) score, and initial electrocardiogram (ECG). The four groups were immediate CTA in the emergency department (ED) without serial markers (n = 98); clinical decision unit/observation unit (CDU) with biomarkers and CTA (n = 102); CDU evaluation with serial cardiac biomarkers and stress testing (n = 154); and usual care, defined as admission with serial biomarkers and hospitalist‐directed evaluation (n = 289). The main outcomes were actual cost of care (facility direct and indirect fixed, facility variable direct labor and supply costs), length of stay (LOS), diagnosis of coronary artery disease (CAD), and safety (30‐day death or myocardial infarction [MI]).
Results: Patients in each group were of similar age (mean ± standard deviation [SD] 46 ± 9 years), race (62% African American), and gender (57% female) and had similar TIMI scores (100% between 0–2). Comparing immediate CTA versus CDU CTA versus CDU stress versus usual care, median costs were less ($1,240 vs. 2,318 vs. 4,024 vs. 2,913; p < 0.01), and LOS was shorter (8.1 hr vs. 20.9 hr vs. 26.2 hr vs. 30.2 hr; p < 0.01). Diagnosis of CAD was similar (5.1% vs. 5.9% vs. 5.8% vs. 6.6%; p = 0.95), but fewer patients had 30‐day death/MI (0% vs. 0% vs. 0.7% vs. 3.1%; p = 0.04) or 30‐day readmission (0% vs. 3.2% vs. 2.3% vs. 12.2%; p < 0.01).
Conclusions: Compared to the other strategies, immediate CTA was as safe, identified as many patients with CAD, had the lowest cost, had the shortest LOS, and allowed discharge for the majority of patients. Larger prospective studies should confirm safety before immediate CTA replaces other strategies to rule out possible ACS.
ACADEMIC EMERGENCY MEDICINE 2008; 15:649–655 © 2008 by the Society for Academic Emergency Medicine</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>18691213</pmid><doi>10.1111/j.1553-2712.2008.00159.x</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | acute coronary syndrome Acute Coronary Syndrome - diagnostic imaging Acute coronary syndromes Biomarkers - analysis Chi-Square Distribution Comparative analysis computed tomography coronary angiography Coronary Angiography - economics cost analysis Costs and Cost Analysis - methods Electrocardiography Emergency medical care Female Heart attacks Humans Male Middle Aged observation unit Retrospective Studies Statistics, Nonparametric Tomography Tomography, X-Ray Computed - economics |
| title | Actual Financial Comparison of Four Strategies to Evaluate Patients with Potential Acute Coronary Syndromes |
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