Direct admission vs. interhospital transfer yields cost, outcomes benefits for non-STEMI
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Key takeaways:
- Direct admission to an intervention center improves outcomes and reduces costs for people with non-STEMI.
- Better prehospital triage protocols are needed for people with chest pain.
Adults with non-STEMI who went directly to a Netherlands intervention center had shorter hospital stays, less time to revascularization and lower costs compared with those who initially presented at a general center, researchers reported.
“When patients with non-ST segment elevation MI are directly admitted to an intervention center, they tend to have shorter hospital stays and the overall cost of treatment is lower,” Gijs J. van Steenbergen, MD, PhD, a cardiology resident at Catharina Heart Centre in Eindhoven, Netherlands, told Healio. “While this study specifically focuses on the system in the Netherlands, the implications are universal. It is clear from our findings that there is a need for a wider reconsideration of how we manage non-STEMI patient care. The potential improvements in both health outcomes and resource efficiency are promising areas that could make a difference to the delivery of care across the globe.”
Claims data analysis
In a retrospective study, Van Steenbergen and colleagues analyzed hospital claims data from 9,167 patients with 9,641 non-STEMI events between 2017 and 2019, including 56% who were admitted to an intervention center and 44% who were admitted to a general center. Researchers compared process indicators, costs and clinical outcomes of patients stratified by center of first presentation (intervention center vs. general center) and revascularization strategy (PCI, CABG or no revascularization).
“For the total population and each cohort, a distinction was made between presentation at an intervention center and presentation at a general center,” the researchers wrote. “A hospital was considered an intervention center if facilities for performing PCI and/or CABG were available on site.”
The primary outcome was the length of hospital stay. Secondary outcomes included duration between admission and diagnostic angiography and revascularization, number of intracoronary procedures, clinical outcomes at 30 days and total costs.
The findings were published in Clinical Cardiology.
The researchers found that duration of hospitalization was shorter for patients with direct presentation at an intervention center vs. a general center for all groups (5 days vs. 7 days; P < .001), as well as for patients who underwent PCI (3 days vs. 5 days; P < .001), those who underwent CABG (16 days vs. 18 days; P < .001) and those who did not undergo revascularization (3 days vs. 4 days; P = .002).
For PCI, direct presentation at an intervention center yielded shorter time to diagnostic angiography (1 day [interquartile range, 0-2] vs. 1 day [interquartile range, 1-2]; P < .001) and revascularization (1 day vs. 4 days; P < .001) and less intracoronary procedures per patient (2 vs. 2; P < .001). For CABG, time to revascularization was shorter (8 days vs. 10 days; P < .001).
Total costs were lower for those with direct presentation at an intervention center vs. a general center for all treatment groups, with mean costs of 10.211 vs. 13.741 (P < .001)/ Major adverse CV events were similar, with rates of 11.8% and 12.4%, respectively (P = .344), as were 30-day mortality rates (intervention center, 3.7%; general center, 3.8%; P = .914).
‘Accurate prehospital triage’ critical
“This study opens up important areas for discussion that extend beyond the Netherlands and are relevant to clinicians worldwide,” van Steenbergen told Healio. “The potential to decrease the length of hospitalizations and costs by streamlining how we admit and treat non-STEMI patients is a significant finding. But there is also a nuanced view to consider: the need for striking a balance between an early invasive strategy and the actual impact on patient outcomes. Accurate prehospital triage and efficient use of health care resources thus become even more critical factors in the overall care strategy for non-STEMI patients.”
Van Steenbergen said the development of reliable, evidence-based methods for prehospital triage of patients with chest pain is an urgent priority.
“This will enable health care providers to more accurately identify high-risk patients and ensure they receive timely and treatment at the most appropriate location,” van Steenbergen told Healio. “Exploring how we can leverage information technologies to improve data sharing is another important area. With the right systems in place, we could significantly speed up the transfer of critical patient data, thereby enhancing the efficiency and quality of care. Lastly, the potential benefits of bundled payment models for non-STEMI care warrant further investigation. By making providers financially accountable for the entire episode of care, such models could both stimulate improvements in care delivery and prevent duplicate claims. This could, ultimately, lead to better patient outcomes and a more cost-effective health care system.”
For more information:
Gijs J. van Steenbergen, MD, PhD, can be reached at gijs.v.steenbergen@catharinaziekenhuis.nl; Twitter: @gjvsteenbergen.
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