Utilization of diagnostic resources and costs in patients with suspected cardiac chest pain

• Published in: European heart journal. Quality of care & clinical outcomes Vol. 7; no. 6; pp. 583 - 590
• Main Authors: Vester, Marijke P M, Eindhoven, Daniëlle C, Bonten, Tobias N, Wagenaar, Holger, Holthuis, Hendrik J, Schalij, Martin J, de Grooth, Greetje J, van Dijkman, Paul R M
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-12-2021
• Subjects: Adult; Aged; Angina pectoris; Angina, Stable; Chest Pain - diagnosis; Chest Pain - etiology; Delivery of Health Care; Expenditures; Female; Humans; Male; Medical diagnosis; Middle Aged; Original; Pain; Pathology; Quality control; Quality improvement; Quality improvement; Angina pectoris; Cost-effectiveness; Chest pain
• ISSN: 2058-5225; 2058-1742
• DOI: 10.1093/ehjqcco/qcaa064

Abstract
Aims
Non-acute chest pain is a common complaint and can be caused by various conditions. With the rising healthcare expenditures of today, it is necessary to use our healthcare resources effectively. This study aims to give insight into the diagnostic effort and costs for patients with non-acute chest pain.
Methods and results
Financial data of patients without a cardiac history from four hospitals (January 2012–October 2018), who were registered with the national diagnostic code ‘no cardiac pathology’ (ICD-10 Z13.6), ‘chest wall syndrome’ (ICD-10 R07.4), or ‘stable angina pectoris’ (ICD-10 I20.9) were extracted. In total, 74 091 patients were included for analysis and divided into the following final diagnosis groups: no cardiac pathology: N = 19 688 (age 53 ± 18), 46% male; chest wall syndrome: N = 40 858 (age 56 ± 15), 45% male; and stable angina pectoris (AP): N = 13 545 (age 67 ± 11), 61% male. A total of approximately €142.7 million was spent during diagnostic work-up. The total expenditure during diagnostic effort was €1.97, €8.13, and €10.7 million, respectively for no cardiac pathology, chest wall syndrome, and stable AP per year. After 8 years of follow-up, ≥95% of the patients diagnosed with no cardiac pathology or chest wall syndrome had an (cardiac) ischaemic-free survival.
Conclusion
The diagnostic expenditure and clinical effort to ascertain non-cardiac chest pain are high. We should define what we as society find acceptable as ‘assurance costs’ with an increasing pressure on the healthcare system and costs.