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Background: Each year, over one million patients in the US are admitted for chest pain. Most patients undergo comprehensive assessments that consume significant resources. However, some lower risk groups leave against medical advice (AMA) before appropriate disposition. Data are sparse regarding characteristics, costs and outcomes of these patients.
Methods: Records of patients admitted for chest pain and who left AMA over 9 months at a single university-affiliated medical center were retrospectively analyzed. Baseline characteristics and comorbidities were obtained. TIMI and HEART scores were calculated and diagnostic testing data were compared. Costs were estimated using a consumer based average hospital cost database. Readmission rates were obtained for a 5-year period after the index AMA admission. Mortality at 12 months was assessed with the social security death index.
Results: Ninety-nine patients met inclusion criteria. Mean length of stay was 57.9 hours (SD + 99.5 hours). Most patients were low to moderate risk (82.7% TIMI score of 0-3 and 96.2% HEART score 0-6) and 10.1% had positive troponins. Hypertension and diabetes were present in 59.6% and 18.2%, respectively, 57.5% of patients were male, and 25.3% had a previous diagnosis of CAD. Substance abuse was common with a 46.5% history of alcohol abuse and 32.3% illicit drug abuse. A total of 62 tests were performed during the index admission: 30 echocardiograms, 20 CT angiograms, 8 nuclear stress tests, 4 left heart catheterizations and 2 PCI. The total average consumer based hospital cost estimate for the AMA cohort was $1.15 million or $11,662 per patient. Within one year 87% had at least 1 readmission, and 30.3% patients were readmitted within 30 days. A history of chronic pain (p-value 0.0033; OR 2.79) and younger age (p-value 0.0073;OR 0.09) were predictive of readmission. All-cause mortality was 0% at 12 months.
Conclusions: Patients admitted with chest pain and subsequently leave AMA have high rates of hypertension and substance abuse, high re-admission rates, and consume significant resources. Further study may provide insight in the need for testing and admission in these low risk patients.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Diabetes and Other Issues in Cardiovascular Prevention
Abstract Category: 32. Prevention: Clinical
Presentation Number: 1277-062
- 2017 American College of Cardiology Foundation