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Triage® Cardiac Panel: Economics & Diagnosis
Prevalence
According to the American Heart Association, 12.6 million people alive today have a history of heart attack, chest pain or both.1
This year an estimated one million Americans will have a new or recurrent heart attack and more than 45 percent of the people who experience a heart attack in a given year will not survive.1
Chest pain complaints are the second leading reason for visits to U.S. emergency departments. Information from the National Hospital Ambulatory Medical Care Survey suggests that in 1998, there were more than five million emergency department visits made by adults suffering from chest pain.2 That number is believed to have since increased to at least six million visits. Among chest pain patients, the highest acuity is associated with those suffering a heart attack. For these patients, time is a significant factor in the race to save their heart muscle and their lives.
Of the patients presenting to emergency departments with chest pain, approximately 40 percent will be admitted to hospitals. Ultimately, only a minor number of these individuals will be diagnosed with a heart attack. Up to 50 percent of chest pain patients will not receive a definitive diagnosis.3
Diagnosing the Cause of Chest Pain
Traditionally, when a patient arrives in the emergency department, the evaluation process for chest pain patients usually includes:
- Medical history, including symptoms and risk factors
- Physical exam
- Electrocardiogram
- Cardiac markers testing
Surveys suggest that approximately 80 percent of chest pain patients receive electrocardiograms (ECG) as part of the diagnostic process.5 ECG, however, has been found to be only 50 percent sensitive for diagnosis of AMI, meaning that half the time the test will be inconclusive.6 Measurements of cardiac markers provide a highly effective means of evaluating chest pain, but results of the test are often not available on an immediate basis. For this reason they tend to be used for confirming suspected heart attacks.
More recently, physicians have been exploring the use of accelerated care pathways that rely on frequent, serial measurements of a combination of cardiac markers to triage chest pain patients in the first few hours after presentation. These new clinical pathways have demonstrated the ability to triage the patient more quickly, leading to better clinical outcomes, and lower costs.
Economic Factors
Patients who present to the emergency department or physician office with chest pain may be suffering from a variety of acute coronary syndromes, or may have another non-cardiovascular disease. Fast and accurate diagnosis is not only vital to patient care, but may also have an economic impact on the hospital.
- Delayed chest pain diagnoses may lead to high costs1 and potential lost revenue for hospitals
- Inappropriate emergency department discharge strategy for Non-ST segment elevation myocardial infarction is the number one malpractice burden for ER physicians2,3
- Over-admission of chest pain patients to ICU often leads to excessive costs4
In 1998, nearly $11 billion was paid to Medicare beneficiaries for coronary heart disease.1 Additionally, it is estimated that each year hospitals admit up to three million people who are later found to be either disease free or suffering from lower acuity conditions. The associated cost of care for these patients may exceed $3 billion.4,5,6 The incidence of chest pain visits may also contribute to overcrowding which, in most dire situations, can result in hospitals diverting patients to other hospitals. This results in additional healthcare costs.
References
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