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Evaluate the effect of invasive (IT) and non-invasive treatment (NIT) modalities on hospitalization cost and readmission rate in patients admitted with cocaine induced chest pain (CICP).
As cocaine use has become more widespread, the number of cocaine-related cardiovascular events and cost of care has increased. A high percentage of patients with cocaine associated chest discomfort are admitted to the hospital, with an average stay of three days. A 9-12 hours observation in a chest pain unit has been validated to be safe in patients with cocaine-associated chest pain who do not have evidence of ischemia or cardiovascular complications, but there is no study in literature assessing the cost benefit and readmission rate of IT vs. NIT in patients with CICP admitted to the hospital.
Retrospectively data of 83 consecutive patients from 2002-2010 who were admitted with CICP with positive urine drug screen was analyzed. Cost of admission of each patient was calculated by including cost of hospital stay, medications, laboratory tests, EKG, cardiac stress test and left heart catheterization. IT arm included patients who underwent left heart catheterization (LHC), NIT arm included patients managed conservatively (with or without stress test). Medical records of these patients were followed for 2 years to look at the number of readmissions for CICP. A Man-Whitney U test was calculated to compare cost in the IT vs. NIT. A Chi-square test was done, to compare the incidence of readmissions between the two groups.
Among patients with CICP, 17 patients underwent IT, 66 patients were managed conservatively (NIT). Overall, average length of stay was 2.7 days and cost of hospitalization was $5336.54. Man-Whitney U test revealed that the total hospitalization cost in the IT group (M-place=69.24) was significantly higher (U=98.000, p<0.001) than the NIT group (M-place=34.98). Median cost in IT group was $8626.06 vs. $3674 in NIT group. 16 patients had at least one readmission in 2 years. Overall, there were 41 re-admissions (Average 0.59 readmissions per person in 2 years). There was no significant difference in the number of readmission between the IT and NIT groups [Chi-square (DF=1) 1.108, p=0.293]
Patient admitted with CICP who were managed conservatively had lower cost of management and similar number of readmissions compared to subjects who were managed invasively. Conservative management can be preferred in patients with CICP.
- 2013 American College of Cardiology Foundation