ASSESSMENT OF COST-EFFECTIVENESS OF SEVERAL STRATEGIES FOR EARLY DIAGNOSIS IN PATIENTS WITH ACUTE NONTRAUMATIC ATYPICAL CHEST PAIN AND NONCONCLUSIVE ELECTROCARDIOGRAM

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BEHRADMANESH S.; DEHGHAN H.; TAVASOLI ALI AKBAR; SARAFZADEGAN NAZILA

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Journal: Journal of Isfahan Medical School Year:2003 | Volume:20 | Issue:67 Page(s): 26-32

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Title

ASSESSMENT OF COST-EFFECTIVENESS OF SEVERAL STRATEGIES FOR EARLY DIAGNOSIS IN PATIENTS WITH ACUTE NONTRAUMATIC ATYPICAL CHEST PAIN AND NONCONCLUSIVE ELECTROCARDIOGRAM

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Abstract

Introduction: One of the most common challenges in the emergency department (ED) is approach to the patients with acute atypical nontraumatic chest pain and nonconclusive ECG. In routine conventional approach the costs are too expensive and the protocol is very conservative. In this study we purposed to identify the low-risk patients, and discharge them as soon as possible, and compared them with conventionally hospitalized low-risk patients for costs, duration of admission, and quality of life.Methods: Patients who reffered to Feiz or Khorshid Hospital, in Isfahan, Iran, from 7.10.1998 to 7.12.2000 with a clinical presentation of acute nontraumatic atypical chest pain and a nonconclusive ECG were enrolled to our interventional clinical trial. All of them were observed in ED for 6h after onset of chest pain. If 6 hrs after onset of pain, they didn't have any conclusive ECG changes and enzymes (Trop.I & CK-MB) were normal, "Quality of life forms" were completed and patients were randomized into 3 different groups. First group were hospitalized and managed with the conventional method. The other 2 groups were evaluated by ET or DASE respectively during 24 after the onset of chest pain. If ET or DASE were negative the patients were discharged rapidly and followed for 2 months. If the results were positive they were hospitalized.Results: Of 197 patients in 3 groups, the difference between mean cost in conventional groups and 2 other groups was significantly meaningful (P<0.001) but was not significant between ET and DASE groups (P>0.05). The difference between mean duration of hospitalization in conventional group and 2 other groups was signiticant (P<0.001) but was not meaningful between ET and DASE groups (P>0.05). Analysis of dada obtained from "Quality of life froms" that submitted at admission and 2 months later Showed sigificant difference between mean improvement score in conventional and DASE groups (P <0.001) and no meaningful difference between ET & DASE and ET & conventional groups (P>0.05). Duning 2 months follow-up period, one sudden cardiac death occurred in "DASE positive" patients and one nonfatal AMI in conventional group.Discussion: According to above results we recommend using ET or especially DASE for approach to the patients with acute atypical nontraumatic chest pain and nonconclusive ECG after a short observational period.

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APA: Copy

BEHRADMANESH, S., DEHGHAN, H., TAVASOLI, ALI AKBAR, & SARAFZADEGAN, NAZILA. (2003). ASSESSMENT OF COST-EFFECTIVENESS OF SEVERAL STRATEGIES FOR EARLY DIAGNOSIS IN PATIENTS WITH ACUTE NONTRAUMATIC ATYPICAL CHEST PAIN AND NONCONCLUSIVE ELECTROCARDIOGRAM. JOURNAL OF ISFAHAN MEDICAL SCHOOL (I.U.M.S), 20(67), 26-32. SID. https://sid.ir/paper/49987/en

Vancouver: Copy

BEHRADMANESH S., DEHGHAN H., TAVASOLI ALI AKBAR, SARAFZADEGAN NAZILA. ASSESSMENT OF COST-EFFECTIVENESS OF SEVERAL STRATEGIES FOR EARLY DIAGNOSIS IN PATIENTS WITH ACUTE NONTRAUMATIC ATYPICAL CHEST PAIN AND NONCONCLUSIVE ELECTROCARDIOGRAM. JOURNAL OF ISFAHAN MEDICAL SCHOOL (I.U.M.S)[Internet]. 2003;20(67):26-32. Available from: https://sid.ir/paper/49987/en

IEEE: Copy

S. BEHRADMANESH, H. DEHGHAN, ALI AKBAR TAVASOLI, and NAZILA SARAFZADEGAN, “ASSESSMENT OF COST-EFFECTIVENESS OF SEVERAL STRATEGIES FOR EARLY DIAGNOSIS IN PATIENTS WITH ACUTE NONTRAUMATIC ATYPICAL CHEST PAIN AND NONCONCLUSIVE ELECTROCARDIOGRAM,” JOURNAL OF ISFAHAN MEDICAL SCHOOL (I.U.M.S), vol. 20, no. 67, pp. 26–32, 2003, [Online]. Available: https://sid.ir/paper/49987/en

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