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Updated: Jul 24, 2025

Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
06:16

Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease

Published on: August 9, 2024

459

Diagnostic and Cost Efficiency of the 0-h/1-h Rule-out and Rule-in Algorithm for Patients With Chest Pain in the

Shun Sasaki1, Kenji Inoue1, Masayuki Shiozaki2

  • 1Department of Cardiovascular Biology and Medicine, Juntendo University Nerima Hospital.

Circulation Journal : Official Journal of the Japanese Circulation Society
|July 2, 2023
PubMed

Insights

The European Society of Cardiology (ESC) 0-hour/1-hour (0/1-h) algorithm for chest pain triage is effective and reduces healthcare costs. This guideline improves risk stratification and economic efficiency in managing patients with chest pain.

Area of Science:

  • Cardiology
  • Health Economics

Background:

  • The European Society of Cardiology (ESC) recommends a 0-hour/1-hour (0/1-h) rule-out and rule-in algorithm using high-sensitivity cardiac troponin assays for chest pain patient triage.
  • Implementing this guideline has potential economic implications for healthcare systems.

Purpose of the Study:

  • To investigate the economic impact and cost-effectiveness of the ESC 0/1-h algorithm in Japan.
  • To evaluate the algorithm's efficiency in risk stratification and cost reduction for chest pain presentations.

Main Methods:

  • A post hoc cost-effectiveness analysis (DROP-ACS study) using deidentified electronic medical records from two Japanese diagnostic centers.
  • Comparison of patient care using the 0/1-h algorithm (Hospital A) versus point-of-care testing (Hospital B).
  • Clinical outcome assessed: all-cause mortality or myocardial infarction within 30 days.

Main Results:

  • Hospital A (0/1-h algorithm) demonstrated high sensitivity (100%) and specificity (95.0%) for the clinical outcome.
  • Hospital B (point-of-care testing) showed lower sensitivity (92.9%) and specificity (89.8%).
  • Implementing the 0/1-h algorithm in Hospital B could decrease urgent coronary angiograms by 50% and reduce medical costs by approximately JPY 4 million.

Conclusions:

  • The ESC 0/1-h algorithm is an efficient strategy for risk stratification in patients with chest pain.
  • Adoption of the 0/1-h algorithm can lead to significant reductions in medical costs.
Abstract

Keywords:
0/1-h algorithmAcute coronary syndromeHigh-sensitivity troponin TMedical costs

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