title: Clinical outcomes and cost effectiveness of accelerated diagnostic protocol in a chest pain center compared with routine care of patients with chest pain.
abstract: OBJECTIVE
  The aim of this study was to compare in patients presenting with acute chest pain the clinical outcomes and cost-effectiveness of an accelerated diagnostic protocol utilizing contemporary technology in a chest pain unit versus routine care in an internal medicine department.
  
  
  RESULTS
  Hospital and 90-day course were prospectively studied in 585 consecutive low-moderate risk acute chest pain patients, of whom 304 were investigated in a designated chest pain center using a pre-specified accelerated diagnostic protocol, while 281 underwent routine care in an internal medicine ward. Hospitalization was longer in the routine care compared with the accelerated diagnostic protocol group (p<0.001). During hospitalization, 298 accelerated diagnostic protocol patients (98%) vs. 57 (20%) routine care patients underwent non-invasive testing, (p<0.001). Throughout the 90-day follow-up, diagnostic imaging testing was performed in 125 (44%) and 26 (9%) patients in the routine care and accelerated diagnostic protocol patients, respectively (p<0.001). Ultimately, most patients in both groups had non-invasive imaging testing. Accelerated diagnostic protocol patients compared with those receiving routine care was associated with a lower incidence of readmissions for chest pain [8 (3%) vs. 24 (9%), p<0.01], and acute coronary syndromes [1 (0.3%) vs. 9 (3.2%), p<0.01], during the follow-up period. The accelerated diagnostic protocol remained a predictor of lower acute coronary syndromes and readmissions after propensity score analysis [OR = 0.28 (CI 95% 0.14-0.59)]. Cost per patient was similar in both groups [($2510 vs. $2703 for the accelerated diagnostic protocol and routine care group, respectively, (p = 0.9)].
  
  
  CONCLUSIONS
  An accelerated diagnostic protocol is clinically superior and as cost effective as routine in acute chest pain patients, and may save time and resources.
authors.affiliation: Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Elad
authors.initials: E
authors.lastname: Asher
authors.affiliation: Ben Gurion University of the Negev, Soroka Medical Center, Beer Sheva, Israel.
authors.forename: Haim
authors.initials: H
authors.lastname: Reuveni
authors.affiliation: Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Nir
authors.initials: N
authors.lastname: Shlomo
authors.affiliation: The School of Public Health, the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yariv
authors.initials: Y
authors.lastname: Gerber
authors.affiliation: Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Roy
authors.initials: R
authors.lastname: Beigel
authors.affiliation: Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Narodetski
authors.affiliation: Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Eldar
authors.affiliation: Emergency Medicine Department, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Jacob
authors.initials: J
authors.lastname: Or
authors.affiliation: Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Hanoch
authors.initials: H
authors.lastname: Hod
authors.affiliation: Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Arie
authors.initials: A
authors.lastname: Shamiss
authors.affiliation: Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Shlomi
authors.initials: S
authors.lastname: Matetzky
mesh_terms: D000368:Aged; D002637:Chest Pain / Q000175:diagnosis* / Q000628:therapy; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D018710:Pain Clinics; D011446:Prospective Studies; D016896:Treatment Outcome