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. 2023 Nov 27;10(2):e002390.
doi: 10.1136/openhrt-2023-002390.

Differences in risk and costs between prehospital identified low-risk men and women with chest pain

Goaris W A Aarts  1 , Cyril Camaro  1 , Laura Rodwell  2 , Eddy M M Adang  2 , Roger van Hout  3 , Gijs Brok  3 , Anouk Hoare  4 , Frank P C de Pooter  5 , Walter de Wit  6 , Gilbert E Cramer  1 , Roland R J van Kimmenade  1 , Eva Ouwendijk  7 , Martijn Rutten  8 , Erwin Zegers  9 , Robert-Jan M van Geuns  1 , Marc E R Gomes  9 , Peter Damman  1 , Niels van Royen  10
Affiliations

Differences in risk and costs between prehospital identified low-risk men and women with chest pain

Goaris W A Aarts et al. Open Heart. .

Abstract

Objective: Prehospital rule-out of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in low-risk patient with a point-of-care troponin measurement reduces healthcare costs with similar safety to standard transfer to the hospital. Risk stratification is performed identical for men and women, despite important differences in clinical presentation, risk factors and age between men and women with NSTE-ACS. Our aim was to compare safety and healthcare costs between men and women in prehospital identified low-risk patients with suspected NSTE-ACS.

Methods: In the Acute Rule-out of non-ST-segment elevation acute coronary syndrome in the (pre)hospital setting by HEART (History, ECG, Age, Risk factors and Troponin) score assessment and a single poInt of CAre troponin randomised trial, the HEAR (History, ECG, Age and Risk factors) score was assessed by ambulance paramedics in suspected NSTE-ACS patients. Low-risk patients (HEAR score ≤3) were included. In this substudy, men and women were compared. Primary endpoint was 30-day major adverse cardiac events (MACE), secondary endpoints were 30-day healthcare costs and the scores for the HEAR score components.

Results: A total of 863 patients were included, of which 495 (57.4%) were women. Follow-up was completed in all patients. In the total population, MACE occurred in 6.8% of the men and 1.6% of the women (risk ratio (RR) 4.2 (95% CI 1.9 to 9.2, p<0.001)). In patients with ruled-out ACS (97% of the total population), MACE occurred in 1.4% of the men and in 0.2% of the women (RR 7.0 (95% CI 2.0 to 14.2, p<0.001). Mean healthcare costs were €504.55 (95% CI €242.22 to €766.87, p<0.001) higher in men, mainly related to MACE.

Conclusions: In a prehospital population of low-risk suspected NSTE-ACS patients, 30-day incidence of MACE and MACE-related healthcare costs were significantly higher in men than in women.

Trial registration number: NCT05466591.

Keywords: acute coronary syndrome; gender; risk stratification.

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Conflict of interest statement

Competing interests: CC reports a grant from ZonMw (The Netherlands Organisation for Health Research and Development) and consulting fees from AstraZeneca and Xenikos BV. RRLvK reports honoraria grants from Bayer and Novartis. PD reports grants from Philips, Abbott and AstraZeneca and consulting fees from Philips. NvR reports grants from Abbott, Philips, Medtronic and Biotronik and speaker fees from Microport, Abbott, Rainmed and Bayer.

Figures

Figure 1
Figure 1
The HEAR (History, ECG, Age and Risk factors) score. BMI, body mass index; LBBB, left bundle branch block; PM, pacemaker.
Figure 2
Figure 2
Healthcare costs in men and women. (A) Healthcare costs in men and women in the total population. (B) Healthcare costs in men and women in the subgroup of patients without MACE. MACE, major adverse cardiac event.
See this image and copyright information in PMC

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