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


METHODS
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.


METHODS
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.
Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. Louise.cullen@health.qld.gov.au.
Louise
L
Cullen
Queensland University of Technology, Brisbane, QLD, Australia.
Jaimi
J
Greenslade
Queensland University of Technology, Brisbane, QLD, Australia.
Katharina
K
Merollini
Queensland University of Technology, Brisbane, QLD, Australia.
Nicholas
N
Graves
Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
Christopher J K
CJ
Hammett
Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
Tracey
T
Hawkins
Christchurch Hospital, Christchurch, New Zealand.
Martin P
MP
Than
Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
Anthony F T
AF
Brown
University of Queensland, Brisbane, QLD, Australia.
Christopher B
CB
Huang
University of Queensland, Brisbane, QLD, Australia.
Seyed E
SE
Panahi
Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
Emily
E
Dalton
Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
William A
WA
Parsonage
D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D001315:Australia; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D011446:Prospective Studies