Cost burden of non-specific chest pain admissions

Background

Non-cardiac aetiologies are common among patients presenting with chest pain.

Aim

To determine the cost of non-specific chest pain admissions to a tertiary referral, teaching hospital.

Methods

Thrombolysis in myocardial infarction risk (TIMI) risk score, lengths of stay (LOS), investigations and diagnoses were recorded for patients admitted with chest pain. Non-specific chest pain was defined as chest pain where cardiac, pulmonary and gastroesophageal aetiologies were excluded. Costs of admissions were calculated.

Results

Of 80 patients, 34 (43 %) and 22 (28 %) were diagnosed with non-specific chest pain and acute coronary syndrome, respectively. Non-specific chest pain admissions had a mean age of 54 (11; 35–74) years, LOS of 3.8 (2.6; 1–11) days and TIMI risk score of 1.4 (1.5; 0–5). Acute coronary syndrome admissions had a mean age of 67 (14; 43–94) years, LOS of 7.7 (4.3; 2–16) days and TIMI risk score of 3.1 (1.2; 0–5). The mean cost per non-specific chest pain admission was €3,729 (2,378; 1,034–10,468), or 48 % of the mean cost per acute coronary syndrome admission of €7,667 (4,279; 1,963–16,071). Bed day costs account for >90 % of overall costs. Only 7 % of patients were weekend discharges. The mean interval to exercise stress test was 2.7(1.5; 1–7) days.

Conclusions

The mean costs of admission and LOS for patients with non-specific chest pain are significant. Extrapolating findings, annual national cost is estimated at approximately €71 million for this cohort, with 73,000 bed days consumed nationally. Delays from admission to tests and low percentage of weekend discharges prolong LOS