Medical consumption compared for TIMI and HEART score in chest pain patients at the emergency department: a retrospective cost analysis
Authors : A Nieuwets, J M Poldervaart, J B Reitsma, S Buitendijk, A J Six, B E Backus, A W Hoes, P A Doevendans
Abstract
Objective
To investigate which risk score (TIMI score or HEART score) identifies the largest population of low-risk patients at the emergency department (ED). Furthermore, we retrospectively calculated the corresponding expected decrease in medical consumption if these patients would have been discharged from the ED.
Methods
We performed analyses in two hospitals of the multicentre prospective validation study of the HEART score, executed in 2008 and 2009. Patients with chest pain presenting to the ED were included and information was collected on major adverse cardiac events (MACEs) and on hospital admissions and diagnostic procedures within 6 weeks. The TIMI and HEART score were calculated for each patient.
Results
We analysed 640 patients (59% male, mean age of 60, cumulative incidence of MACE 17%). An estimated total of €763 468 was spent during follow-up on hospital admission and diagnostic procedures. In total, 256 (40%) patients had a HEART score of 0–3 and were considered low risk (miss rate 1.6%), a total of €64 107 was spent on diagnostic procedures and hospital admission after initial presentation in this group. In comparison, 105 (16%) patients with TIMI score of 0 were considered low risk (miss rate 0%), with a total of €14 670 spent on diagnostic procedures and initial hospital admission costs. With different cut-offs for low risk, HEART 0–2 (miss rate 0.7%), would have resulted in a total of €25 365 in savings, compared with €71 905 when an alternative low risk cut-off for TIMI of TIMI≤1 would be used (miss rate 3.0%).
Conclusions
The HEART score identifies more patients as low risk compared with the TIMI score, which may lead to a larger reduction in diagnostic procedures and costs in this low-risk group. Future studies should prospectively investigate whether adhering to the HEART score in clinical practice and early discharge of low-risk patients is safe and leads to a reduction in medical consumption.
Citation: A Nieuwets, J M Poldervaart, J B Reitsma, S Buitendijk, A J Six, B E Backus, A W Hoes, P A Doevendans Medical consumption compared for TIMI and HEART score in chest pain patients at the emergency department: a retrospective cost analysis BMJ Open 2016;6:e010694 doi:10.1136/bmjopen-2015-010694
Received: 27 November 2015 Revised: 1 March 2016 Accepted: 22 March 2016 Published: 16 June 2016
Copyright: This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Contributors
BEB and AJS designed the study. BEB, AJS, JMP, JBR and SB together with all participating hospitals acquired the data. JMP, JBR, AN and SB analysed the data. JMP, JBR and AN drafted the manuscript. All authors read and approved the final manuscript.
Funding The original multicentre validation study of 2388 patients concerned an unfunded study.17
Competing interests
Two authors (BEB and AJS) were involved in the development of the HEART score. The authors declare that they have no other competing interests.
