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Demandt J, Koks A, Sagel D, van Hattem VAE, Haest RJ, Heijmen E, Thijssen H, Otterspoor LC, van Veghel D, Eerdekens R, El Farissi M, Teeuwen K, Wijnbergen I, van der Harst P, Pijls NHJ, van 't Veer M, Tonino PAL, Dekker LRC, Vlaar PJ. Prehospital risk assessment and direct transfer to a percutaneous coronary intervention centre in suspected acute coronary syndrome. Heart 2024; 110:408-415. [PMID: 38040452 DOI: 10.1136/heartjnl-2023-323346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/16/2023] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVE Prehospital risk stratification and triage are currently not performed in patients suspected of non-ST-segment elevation acute coronary syndrome (NSTE-ACS). This may lead to prolonged time to revascularisation, increased duration of hospital admission and higher healthcare costs. The preHEART score (prehospital history, ECG, age, risk factors and point-of-care troponin score) can be used by emergency medical services (EMS) personnel for prehospital risk stratification and triage decisions in patients with NSTE-ACS. The aim of the current study was to evaluate the effect of prehospital risk stratification and direct transfer to a percutaneous coronary intervention (PCI) centre, based on the preHEART score, on time to final invasive diagnostics or culprit revascularisation. METHODS Prospective, multicentre, two-cohort study in patients with suspected NSTE-ACS. The first cohort is observational (standard care), while the second (interventional) cohort includes patients who are stratified for direct transfer to either a PCI or a non-PCI centre based on their preHEART score. Risk stratification and triage are performed by EMS personnel. The primary endpoint of the study is time from first medical contact until final invasive diagnostics or revascularisation. Secondary endpoints are time from first medical contact until intracoronary angiography (ICA), duration of hospital admission, number of invasive diagnostics, number of inter-hospital transfers and major adverse cardiac events at 7 and 30 days. RESULTS A total of 1069 patients were included. In the interventional cohort (n=577), time between final invasive diagnostics or revascularisation (42 (17-101) hours vs 20 (5-44) hours, p<0.001) and length of hospital admission (3 (2-5) days vs 2 (1-4) days, p=0.007) were shorter than in the observational cohort (n=492). In patients with NSTE-ACS in need for ICA or revascularisation, healthcare costs were reduced in the interventional cohort (€5599 (2978-9625) vs €4899 (2278-5947), p=0.02). CONCLUSION Prehospital risk stratification and direct transfer to a PCI centre, based on the preHEART score, reduces time from first medical contact to final invasive diagnostics and revascularisation, reduces duration of hospital admission and decreases healthcare costs in patients with NSTE-ACS in need for ICA or revascularisation. TRIAL REGISTRATION NCT05243485.
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Affiliation(s)
- Jesse Demandt
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Arjan Koks
- GGD Brabant-Zuidoost, Eindhoven, Netherlands
| | - Dennis Sagel
- Cardioresearch, Faculty of Medical Sciences, University of Groningen, Groningen, Netherlands
| | | | - Rutger J Haest
- Cardiology, St. Anna Hospital, Geldrop, Netherlands
- Netherlands Heart Network, Helmond, Netherlands
| | - Eric Heijmen
- Netherlands Heart Network, Helmond, Netherlands
- Cardiology, Elkerliek Hospital, Helmond, Netherlands
| | - H Thijssen
- Netherlands Heart Network, Helmond, Netherlands
- Cardiology, Maxima Medical Centre, Veldhoven, Netherlands
| | - Luuk C Otterspoor
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Dennis van Veghel
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
- Netherlands Heart Network, Helmond, Netherlands
| | - Rob Eerdekens
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | | | - Koen Teeuwen
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Inge Wijnbergen
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Pim van der Harst
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Nico H J Pijls
- Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Marcel van 't Veer
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
- Cardioresearch, Faculty of Medical Sciences, University of Groningen, Groningen, Netherlands
| | - Pim A L Tonino
- Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Lukas R C Dekker
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
- Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Pieter J Vlaar
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
- Netherlands Heart Network, Helmond, Netherlands
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Groen RA, Jukema JW, van Dijkman PRM, Timmermans PT, Bax JJ, Lamb HJ, de Graaf MA. Evaluation of Clinical Applicability of Coronary Artery Calcium Assessment on Non-Gated Chest Computed Tomography, Compared With the Classic Agatston Score on Cardiac Computed Tomography. Am J Cardiol 2023; 208:92-100. [PMID: 37820552 DOI: 10.1016/j.amjcard.2023.08.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 10/13/2023]
Abstract
Given current pretest probability (PTP) estimations tend to overestimate patients' risk for obstructive coronary artery disease, evaluation of patients' coronary artery calcium (CAC) is more precise. The value of CAC assessment with the Agatston score on cardiac computed tomography (CT) for risk estimation has been well indicated in patients with stable chest pain. CAC can be equally well assessed on routine non-gated chest CT, which is often available. This study aims to determine the clinical applicability of CAC assessment on non-gated CT in patients with stable chest pain compared with the classic Agatston score on gated CT. Consecutive patients referred for evaluation of the Agatston score, who had a previously performed non-gated chest CT for evaluation of noncardiac diseases, were included. CAC on non-gated CT was ordinally scored. Subsequently, patients were stratified according to CAC severity and PTP. The agreement and correlation between the classic Agatston score and CAC on non-gated CT were evaluated. The discriminative power for risk reclassification of both CAC assessment methods was assessed. Invasive coronary angiography was used as the gold standard, when available. A total of 140 patients aged between 30 and 88 years were included. The agreement between ordinally scored CAC and the Agatston score was excellent (κ = 0.82) and the correlation strong (r = 0.94). Most patients (80%) with an intermediate PTP had no or mild CAC on non-gated CT. They were reclassified at low risk with 100% accuracy compared with invasive coronary angiography. Similarly, 86% of patients had an Agatston score <300. These patients were reclassified with 98% accuracy. In patients with high PTP, the accuracy remained substantial and comparable, 94% and 89%, respectively. In conclusion, we believe this is the first study to assess the clinical applicability of CAC on non-gated CT in patients with stable chest pain, compared with the classic Agatston score. The agreement between methods was excellent and the correlation strong. Furthermore, CAC assessment on non-gated CT could reclassify patients' risk for obstructive coronary artery disease as accurately as could the classic Agatston score.
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Affiliation(s)
- Roos A Groen
- Department of Cardiology, Leiden University Medical Center, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, The Netherlands; The Netherlands Heart Institute, Utrecht, The Netherlands.
| | | | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel A de Graaf
- Department of Cardiology, Leiden University Medical Center, The Netherlands
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Tolsma RT, de Koning ER, Fokkert MJ, van der Waarden NW, van 't Hof AW, Backus BE. Management of patients suspected for non-ST elevation-acute coronary syndrome in the prehospital phase. Future Cardiol 2023; 19:639-647. [PMID: 37916603 DOI: 10.2217/fca-2023-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/03/2023] [Indexed: 11/03/2023] Open
Abstract
The management of patients with suspected acute coronary syndrome, especially in prehospital settings, is challenging. This Special Report focuses on studies in emergency medical services concerning chest pain patients' triage and risk stratification. In addition, it emphasizes advancements in point-of-care cardiac troponin testing. These developments are compared with in-hospital guidelines, proposing an initial framework for a new acute care pathway. This pathway integrates a risk stratification tool with high-sensitivity cardiac troponin testing, aiming to deliver optimal care and collaboration within the acute care chain. It has the potential to contribute to a significant reduction in hospital referrals, reduce observation time and overcrowding at emergency departments and hospital admissions.
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Affiliation(s)
- Rudolf T Tolsma
- Emergency Medical Service, Ambulance IJsselland, Zwolle, 8013 PM, The Netherlands
| | - Enrico R de Koning
- Department of Cardiology, Leiden University Medical Center, Leiden, 2333 ZA, The Netherlands
| | - Marion J Fokkert
- Department of Clinical Chemistry, Isala, Zwolle, 8025 AB, The Netherlands
| | | | - Arnoud Wj van 't Hof
- Department of Cardiology, Maastricht University Medical Center, Maastricht, 6229 HX, The Netherlands
- Department of Cardiology, Zuyderland MC, Heerlen, 6419 PC, The Netherlands
| | - Barbra E Backus
- Emergency Department, Franciscus Gasthuis & Vlietland, Rotterdam, 3043 PM, The Netherlands
- Emergency Department, Elisabeth-Tweesteden hospital, Tilburg, 5000 LC, The Netherlands
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Hughes ME, Chico TJA. How Could Sensor-Based Measurement of Physical Activity Be Used in Cardiovascular Healthcare? SENSORS (BASEL, SWITZERLAND) 2023; 23:8154. [PMID: 37836984 PMCID: PMC10575134 DOI: 10.3390/s23198154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023]
Abstract
Physical activity and cardiovascular disease (CVD) are intimately linked. Low levels of physical activity increase the risk of CVDs, including myocardial infarction and stroke. Conversely, when CVD develops, it often reduces the ability to be physically active. Despite these largely understood relationships, the objective measurement of physical activity is rarely performed in routine healthcare. The ability to use sensor-based approaches to accurately measure aspects of physical activity has the potential to improve many aspects of cardiovascular healthcare across the spectrum of healthcare, from prediction, prevention, diagnosis, and treatment to disease monitoring. This review discusses the potential of sensor-based measurement of physical activity to augment current cardiovascular healthcare. We highlight many factors that should be considered to maximise the benefit and reduce the risks of such an approach. Because the widespread use of such devices in society is already a reality, it is important that scientists, clinicians, and healthcare providers are aware of these considerations.
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Affiliation(s)
- Megan E. Hughes
- Clinical Medicine, School of Medicine and Population Health, The Medical School, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK
| | - Timothy J. A. Chico
- Clinical Medicine, School of Medicine and Population Health, The Medical School, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK
- British Heart Foundation Data Science Centre, Health Data Research, London WC1E 6BP, UK
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Dawson L, Nehme E, Nehme Z, Zomer E, Bloom J, Cox S, Anderson D, Stephenson M, Lefkovits J, Taylor A, Kaye D, Cullen L, Smith K, Stub D. Healthcare cost burden of acute chest pain presentations. Emerg Med J 2023; 40:437-443. [PMID: 36918268 DOI: 10.1136/emermed-2022-212674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 02/19/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND This study aimed to estimate the direct healthcare cost burden of acute chest pain attendances presenting to ambulance in Victoria, Australia, and to identify key cost drivers especially among low-risk patients. METHODS State-wide population-based cohort study of consecutive adult patients attended by ambulance for acute chest pain with individual linkage to emergency and hospital admission data in Victoria, Australia (1 January 2015-30 June 2019). Direct healthcare costs, adjusted for inflation to 2020-2021 ($A), were estimated for each component of care using a casemix funding method. RESULTS From 241 627 ambulance attendances for chest pain during the study period, mean chest pain episode cost was $6284, and total annual costs were estimated at $337.4 million ($68 per capita per annum). Total annual costs increased across the period ($310.5 million in 2015 vs $384.5 million in 2019), while mean episode costs remained stable. Cardiovascular conditions (25% of presentations) were the most expensive (mean $11 523, total annual $148.7 million), while a non-specific pain diagnosis (49% of presentations) was the least expensive (mean $3836, total annual $93.4 million). Patients classified as being at low risk of myocardial infarction, mortality or hospital admission (Early Chest pain Admission, Myocardial infarction, and Mortality (ECAMM) score) represented 31%-57% of the cohort, with total annual costs estimated at $60.6 million-$135.4 million, depending on the score cut-off used. CONCLUSIONS Total annual costs for acute chest pain presentations are increasing, and a significant proportion of the cost burden relates to low-risk patients and non-specific pain. These data highlight the need to improve the cost-efficiency of chest pain care pathways.
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Affiliation(s)
- Luke Dawson
- Department of Cardiology, Alfred Hospital, Prahran, Victoria, Australia .,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Emily Nehme
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia
| | - Ziad Nehme
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia
| | - Ella Zomer
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jason Bloom
- Department of Cardiology, Alfred Hospital, Prahran, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Shelley Cox
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia
| | - David Anderson
- Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia.,Intensive Care and Hyperbaric Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Michael Stephenson
- Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia
| | - Jeffrey Lefkovits
- Department of Cardiology, Melbourne Health, Parkville, Victoria, Australia
| | - Andrew Taylor
- Department of Cardiology, Alfred Hospital, Prahran, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - David Kaye
- Department of Cardiology, Alfred Hospital, Prahran, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Louise Cullen
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Karen Smith
- Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Hospital, Prahran, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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van den Bulk S, Spoelman WA, van Dijkman PRM, Numans ME, Bonten TN. Non-acute chest pain in primary care; referral rates, communication and guideline adherence: a cohort study using routinely collected health data. BMC PRIMARY CARE 2022; 23:336. [PMID: 36550420 PMCID: PMC9784001 DOI: 10.1186/s12875-022-01939-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The prevalence of coronary artery disease is increasing due to the aging population and increasing prevalence of cardiovascular risk factors. Non-acute chest pain often is the first symptom of stable coronary artery disease. To optimise care for patients with non-acute chest pain and make efficient use of available resources, we need to know more about the current incidence, referral rate and management of these patients. METHODS We used routinely collected health data from the STIZON data warehouse in the Netherlands between 2010 and 2016. Patients > 18 years, with no history of cardiovascular disease, seen by the general practitioner (GP) for non-acute chest pain with a suspected cardiac origin were included. Outcomes were (i) incidence of new non-acute chest pain in primary care, (ii) referral rates to the cardiologist, (iii) correspondence from the cardiologist to the GP, (iv) registration by GPs of received correspondence and; (v) pharmacological guideline adherence after newly diagnosed stable angina pectoris. RESULTS In total 9029 patients were included during the study period, resulting in an incidence of new non-acute chest pain of 1.01/1000 patient-years. 2166 (24%) patients were referred to the cardiologist. In 857/2114 (41%) referred patients, correspondence from the cardiologist was not available in the GP's electronic medical record. In 753/1257 (60%) patients with available correspondence, the GP did not code the conclusion in the electronic medical record. Despite guideline recommendations, 37/255 (15%) patients with angina pectoris were not prescribed antiplatelet therapy nor anticoagulation, 69/255 (27%) no statin and 67/255 (26%) no beta-blocker. CONCLUSION After referral, both communication from cardiologists and registration of the final diagnosis by GPs were suboptimal. Both cardiologists and GPs should make adequate communication and registration a priority, as it improves health outcomes. Secondary pharmacological prevention in patients with angina pectoris was below guideline standards. So, proactive attention needs to be given to optimise secondary prevention in this high-risk group in primary care.
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Affiliation(s)
- Simone van den Bulk
- grid.10419.3d0000000089452978Department of Public Health and Primary Care, Leiden University Medical Center, Postzone V0-P, Postbus 9600, 2300 RC Leiden, The Netherlands
| | - Wouter A. Spoelman
- grid.10419.3d0000000089452978Department of Public Health and Primary Care, Leiden University Medical Center, Postzone V0-P, Postbus 9600, 2300 RC Leiden, The Netherlands
| | - Paul R. M. van Dijkman
- grid.10419.3d0000000089452978Department of Cardiology, Leiden University Medical Center, Postzone V0-P, Postbus 9600, 2300 RC Leiden, The Netherlands
| | - Mattijs E. Numans
- grid.10419.3d0000000089452978Department of Public Health and Primary Care, Leiden University Medical Center, Postzone V0-P, Postbus 9600, 2300 RC Leiden, The Netherlands
| | - Tobias N. Bonten
- grid.10419.3d0000000089452978Department of Public Health and Primary Care, Leiden University Medical Center, Postzone V0-P, Postbus 9600, 2300 RC Leiden, The Netherlands
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Moumneh T, Penaloza A, Charpentier S, Douillet D, Prunier F, Riou J, Roy PM. Efficacy of HEAR and HEART score to rule out major adverse cardiac events in patients presenting to the emergency department with chest pain: study protocol of the eCARE stepped-wedge randomised control trial. BMJ Open 2022; 12:e066953. [PMID: 36600358 PMCID: PMC9730388 DOI: 10.1136/bmjopen-2022-066953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Current guidelines for patients presenting to the emergency department (ED) with chest pain without ST-segment elevation myocardial infarction (STEMI) on ECG are based on serial troponin measurements. A clinical tool able to identify very low-risk patients who could forgo a troponin test and low-risk patients requiring only one troponin measurement would be of great interest. To do so, the HEAR and HEART score, standing for history, ECG, age, risk factors±troponin were prospectively assessed, but not combined and implemented in clinical practice. The objective of the eCARE study is to assess the impact of implementing a diagnostic strategy based on a HEAR score <2 or a HEART score <4 (HEAR-T strategy) to rule out non-STEMI without or with a single troponin measurement in patients presenting to the ED with chest pain without obvious diagnosis after physical examination and an ECG. METHODS AND ANALYSIS Stepped-wedge cluster-randomised control trial in 10 EDs. Patients with non-traumatic chest pain and no formal diagnosis were included and followed for 30 days. In the interventional phase, the doctor will be asked not to perform a troponin test to look for an acute coronary if the HEAR score is <2 and not to perform an additional troponin test if the HEAR score is ≥2 and HEART score is <4. The main endpoint is the non-inferiority of the rates of major adverse cardiac events occurring between a patient's discharge and the 30-day follow-up against current recommended guidelines. ETHICS AND DISSEMINATION The study was approved by an institutional review board for all participating centres. If successful, the eCARE study will cover a gap in the evidence, proving that it is safe and efficient to rule out the hypothesis of an acute myocardial infarction in some selected very low-risk patients or based on a single troponin measurement in some low-risk patients. TRIAL REGISTRATION NUMBER NCT04157790.
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Affiliation(s)
- Thomas Moumneh
- Département de Médecine d'Urgence, CHU d'Angers, Angers, France
- Institut MitoVasc, UMR CNRS 6215 INSERM 1083, Université d'Angers, Angers, France
| | - Andrea Penaloza
- Service de Médecine d'Urgence, Cliniques Universitaires St-Luc, Brussels, Belgium
| | - Sandrine Charpentier
- Département de médecine d'Urgence, Hopital Purpan - CHU de Toulouse, Toulouse, France
- Laboratoire d'épidemiologie et d'analyse en santé publique, UMR 1027 INSERM, F-31000, Toulouse III - Paul Sabatier University, Toulouse, France
| | - Delphine Douillet
- Département de Médecine d'Urgence, CHU d'Angers, Angers, France
- Institut MitoVasc, UMR CNRS 6215 INSERM 1083, Université d'Angers, Angers, France
| | - Fabrice Prunier
- Institut MitoVasc, UMR CNRS 6215 INSERM 1083, Université d'Angers, Angers, France
- Département de Cardiologie, CHU d'Angers, Angers, France
| | - Jérémie Riou
- Département de biostatstiques et de métodologie, CHU d'Angers, Angers, France
- MINT, INSERM UMR 1066, CNRS UMR 6021, Université Angers, Angers, France
| | - Pierre-Marie Roy
- Département de Médecine d'Urgence, CHU d'Angers, Angers, France
- Institut MitoVasc, UMR CNRS 6215 INSERM 1083, Université d'Angers, Angers, France
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Dawson LP, Smith K, Cullen L, Nehme Z, Lefkovits J, Taylor AJ, Stub D. Care Models for Acute Chest Pain That Improve Outcomes and Efficiency. J Am Coll Cardiol 2022; 79:2333-2348. [DOI: 10.1016/j.jacc.2022.03.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
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Salet N, Stangenberger VA, Eijkenaar F, Schut FT, Schut MC, Bremmer RH, Abu-Hanna A. Identifying prognostic factors for clinical outcomes and costs in four high-volume surgical treatments using routinely collected hospital data. Sci Rep 2022; 12:5902. [PMID: 35393507 PMCID: PMC8989991 DOI: 10.1038/s41598-022-09972-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 03/29/2022] [Indexed: 11/16/2022] Open
Abstract
Identifying prognostic factors (PFs) is often costly and labor-intensive. Routinely collected hospital data provide opportunities to identify clinically relevant PFs and construct accurate prognostic models without additional data-collection costs. This multicenter (66 hospitals) study reports on associations various patient-level variables have with outcomes and costs. Outcomes were in-hospital mortality, intensive care unit (ICU) admission, length of stay, 30-day readmission, 30-day reintervention and in-hospital costs. Candidate PFs were age, sex, Elixhauser Comorbidity Score, prior hospitalizations, prior days spent in hospital, and socio-economic status. Included patients dealt with either colorectal carcinoma (CRC, n = 10,254), urinary bladder carcinoma (UBC, n = 17,385), acute percutaneous coronary intervention (aPCI, n = 25,818), or total knee arthroplasty (TKA, n = 39,214). Prior hospitalization significantly increased readmission risk in all treatments (OR between 2.15 and 25.50), whereas prior days spent in hospital decreased this risk (OR between 0.55 and 0.95). In CRC patients, women had lower risk of in-hospital mortality (OR 0.64), ICU admittance (OR 0.68) and 30-day reintervention (OR 0.70). Prior hospitalization was the strongest PF for higher costs across all treatments (31–64% costs increase/hospitalization). Prognostic model performance (c-statistic) ranged 0.67–0.92, with Brier scores below 0.08. R-squared ranged from 0.06–0.19 for LoS and 0.19–0.38 for costs. Identified PFs should be considered as building blocks for treatment-specific prognostic models and information for monitoring patients after surgery. Researchers and clinicians might benefit from gaining a better insight into the drivers behind (costs) prognosis.
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Affiliation(s)
- N Salet
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
| | - V A Stangenberger
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,LOGEX b.v., Amsterdam, The Netherlands
| | - F Eijkenaar
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - F T Schut
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - M C Schut
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - A Abu-Hanna
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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