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Comparative Study
. 2015 Jan 26;10(1):e0117287.
doi: 10.1371/journal.pone.0117287. eCollection 2015.

Clinical outcomes and cost effectiveness of accelerated diagnostic protocol in a chest pain center compared with routine care of patients with chest pain

Elad Asher  1 , Haim Reuveni  2 , Nir Shlomo  1 , Yariv Gerber  3 , Roy Beigel  1 , Michael Narodetski  1 , Michael Eldar  1 , Jacob Or  4 , Hanoch Hod  1 , Arie Shamiss  5 , Shlomi Matetzky  1
Affiliations
Comparative Study

Clinical outcomes and cost effectiveness of accelerated diagnostic protocol in a chest pain center compared with routine care of patients with chest pain

Elad Asher et al. PLoS One. .

Abstract

Aims: 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.

Methods and 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)].

Conclusion: An accelerated diagnostic protocol is clinically superior and as cost effective as routine in acute chest pain patients, and may save time and resources.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Patients’ enrollment scheme.
Fig 2
Fig 2. Diagnostic imaging testing performed in the community during 90 days of follow-up.
RC—Routine care; ADP—Accelerated diagnostic protocol; MPS—Myocardial perfusion scintigraphy; MDCT—Multi-detector computed tomography; Echo—Echocardiography.
See this image and copyright information in PMC

References

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