7. Economic outcomes from chest pain centers

The goals of chest pain centers are to triage and evaluate patients, provide rapid patient treatment, and optimize resource utilization. Chest pain centers do not require separate facilities and can coexist within the emergency department, requiring only an area where patients can be observed. The initial change must occur in the clinician's mindset - patients must be observed as long as necessary. This is a major deviation from the emergency room mentality that stresses rapid stabilization and processing of patients; in the absence of acute or traumatic injury, the patients - usually are discharged. However, in the chest pain center, patients with moderate-to-low risk of acute ischemic coronary syndromes may be observed, treated, and evaluated for up to 9 h, with stress testing or sequential biochemical markers tested before a decision is made.

Studies evaluating the cost of heart attack care of low-probability ischemic patients have demonstrated a reduction in costs per patient between $1000 and $3000 (Table 2). Chest pain centers provide rapid and safe evaluation and appropriate treatment of chest pain patients at costs of between 20 and 50% of the typical 1- to 3-day inpatient work-up. Additionally, chest pain centers reduce the number of hospital admissions for patients who are eventually diagnosed with pain of non cardiac origin - admissions that are estimated to cost $3.5 billion annually [45,48]. Care-ful screening of cardiac patients allows for approximately 80% of patients with low-to-moderate risk of ischemia to be discharged [34,49].