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Published on: August 9, 2024
Differences in risk and costs between prehospital identified low-risk men and women with chest pain
Goaris W A Aarts1, Cyril Camaro1, Laura Rodwell2
1Department of Cardiology, Radboudumc, Nijmegen, The Netherlands.
Insights
Men with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) had higher rates of major adverse cardiac events (MACE) and related healthcare costs compared to women in a prehospital setting. This highlights sex-based differences in NSTE-ACS risk stratification.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Economics
Background:
- Prehospital rule-out of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) using point-of-care troponin testing is cost-effective and safe for low-risk patients.
- Current risk stratification for NSTE-ACS does not account for known sex-based differences in clinical presentation, risk factors, and age.
- This study aimed to compare the safety and healthcare costs between men and women in a prehospital setting for suspected NSTE-ACS.
Purpose of the Study:
- To compare the 30-day incidence of major adverse cardiac events (MACE) between men and women with suspected NSTE-ACS.
- To compare 30-day healthcare costs between men and women with suspected NSTE-ACS.
- To analyze differences in HEAR score components between sexes in this low-risk population.
Main Methods:
- Utilized data from the Acute Rule-out of NSTE-ACS in the (pre)hospital setting by HEART score assessment and a single point-of-care troponin randomized trial.
- Ambulance paramedics assessed the HEAR (History, ECG, Age, Risk factors) score in suspected NSTE-ACS patients.
- Low-risk patients (HEAR score ≤3) were included in this substudy comparing men and women, with 30-day MACE and healthcare costs as primary and secondary endpoints.
Main Results:
- A total of 863 patients were included, with 57.4% being women.
- The overall 30-day MACE incidence was 6.8% in men versus 1.6% in women (RR 4.2).
- Mean healthcare costs were €504.55 higher in men, primarily linked to MACE, with MACE occurring in 1.4% of men and 0.2% of women with ruled-out ACS.
Conclusions:
- In low-risk patients with suspected NSTE-ACS, men exhibited significantly higher 30-day MACE rates and associated healthcare costs compared to women.
- These findings underscore the need to consider sex-specific differences in the prehospital management and risk stratification of NSTE-ACS.
- The HEAR score and point-of-care troponin strategy demonstrated similar safety but revealed significant sex-based disparities in outcomes and costs.
Objective:
Prehospital rule-out of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in low-risk patient with a point-of-care troponin measurement reduces healthcare costs with similar safety to standard transfer to the hospital. Risk stratification is performed identical for men and women, despite important differences in clinical presentation, risk factors and age between men and women with NSTE-ACS. Our aim was to compare safety and healthcare costs between men and women in prehospital identified low-risk patients with suspected NSTE-ACS.
Methods:
In the Acute Rule-out of non-ST-segment elevation acute coronary syndrome in the (pre)hospital setting by HEART (History, ECG, Age, Risk factors and Troponin) score assessment and a single poInt of CAre troponin randomised trial, the HEAR (History, ECG, Age and Risk factors) score was assessed by ambulance paramedics in suspected NSTE-ACS patients. Low-risk patients (HEAR score ≤3) were included. In this substudy, men and women were compared. Primary endpoint was 30-day major adverse cardiac events (MACE), secondary endpoints were 30-day healthcare costs and the scores for the HEAR score components.
Results:
A total of 863 patients were included, of which 495 (57.4%) were women. Follow-up was completed in all patients. In the total population, MACE occurred in 6.8% of the men and 1.6% of the women (risk ratio (RR) 4.2 (95% CI 1.9 to 9.2, p<0.001)). In patients with ruled-out ACS (97% of the total population), MACE occurred in 1.4% of the men and in 0.2% of the women (RR 7.0 (95% CI 2.0 to 14.2, p<0.001). Mean healthcare costs were €504.55 (95% CI €242.22 to €766.87, p<0.001) higher in men, mainly related to MACE.
Conclusions:
In a prehospital population of low-risk suspected NSTE-ACS patients, 30-day incidence of MACE and MACE-related healthcare costs were significantly higher in men than in women.
Trial Registration Number:
NCT05466591.
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