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  • Title: Updated management of non-st-segment elevation acute coronary syndromes: selection of patients for low-cost care: an analysis of outcome and cost effectiveness.
    Author: Conti A, Pieralli F, Sammicheli L, Camaiti A, Vanni S, Grifoni S, Dovellini E, Antoniucci D, Squillantini G, Mazzuoli F, Colombo G.
    Journal: Med Sci Monit; 2005 Mar; 11(3):CR100-8. PubMed ID: 15735561.
    Abstract:
    BACKGROUND: The management of patients with acute coronary syndromes without ST-segment elevation (NSTEACS) in a chest pain unit (CPU) should represent a cost-effective advantage over conventional management in a coronary care unit (CCU). However, the safety and advantages of this approach are still unresolved. MATERIAL/METHODS: Outcomes and management costs were evaluated in patients with NSTEACS with intermediate-high TIMI risk scores (> or =3) randomized to receive management in a CPU or a CCU. Coronary events (CEs: angina, myocardial infarction, and death), revascularization, and resource utilization were compared between the two groups during hospital stay and at 6 months. RESULTS: Two hundred and ten patients were enrolled, 104 in the CPU and 106 in the CCU group. CEs were similar in both groups both during hospitalization (28% vs. 26%, respectively) and at 6 months (17% vs. 16%). Angiography was performed in 67% vs. 75%; CPU patients less frequently underwent revascularization (53% vs. 76%; p=0.002). In-hospital duration was similar in both groups (7.5 days vs. 5.7 days). CPU patients had a 22% reduction in overall hospitalization costs compared with conventional management (9,913 vs. 12,056 euros/patient; p=0.01). This gain was particularly relevant (29%) when patients with TIMI risk score < or =4 were considered (10,599 vs. 13,699 euros/patient; p=0.004). CONCLUSIONS: CPU care of NSTEACS is a safe and cost-effective alternative to conventional CCU management, particularly appealing with regard to patients presenting with intermediate TIMI risk score (< or =4) in whom CPU management could optimize the use of cath-lab facilities and dedicated cardiologists.
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