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

• Project/Area Number: 18K09954
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Review Section: Basic Section 58010:Medical management and medical sociology-related
• Research Institution: Juntendo University
• Principal Investigator: Inoue Kenji 順天堂大学, 医学部, 准教授 (80317388)
• Co-Investigator(Kenkyū-buntansha): 渡邊 亮 神奈川県立保健福祉大学, ヘルスイノベーション研究科, 准教授 (90756173)
• Project Period (FY): 2018-04-01 – 2023-03-31
• Project Status: Completed (Fiscal Year 2022)
• Budget Amount: ¥4,420,000 (Direct Cost: ¥3,400,000、Indirect Cost: ¥1,020,000); Fiscal Year 2022: ¥390,000 (Direct Cost: ¥300,000、Indirect Cost: ¥90,000); Fiscal Year 2021: ¥520,000 (Direct Cost: ¥400,000、Indirect Cost: ¥120,000); Fiscal Year 2020: ¥910,000 (Direct Cost: ¥700,000、Indirect Cost: ¥210,000); Fiscal Year 2019: ¥1,430,000 (Direct Cost: ¥1,100,000、Indirect Cost: ¥330,000); Fiscal Year 2018: ¥1,170,000 (Direct Cost: ¥900,000、Indirect Cost: ¥270,000)
• Keywords: 急性冠症候群 / 0/1-hアルゴリズム / 医療費 / 高感度トロポニン / 医療費削減 / 胸痛 / バイオマーカー / 医療費削減効果 / 医療経済 / 救急外来 / 急性心筋梗塞 / 救急医療

Outline of Final Research Achievements

Background: This study aimed to understand the economic impact of the 0h/1h algorithm with high-sensitivity cardiac troponin assays for chest pain triage. Methods and Results: A cost-effectiveness analysis was conducted with 472 patients following the 0/1-h algorithm (Hospital A) and 427 patients following the point of care testing (Hospital B). The clinical outcome was all-cause mortality or subsequent myocardial infarction within 30 days. The sensitivity and specificity for the clinical outcome were 100% and 95.0% in Hospital A and 92.9% and 89.8% in Hospital B. Assuming the diagnostic accuracy of the 0/1-h algorithm was implemented in Hospital B, the number of urgent coronary angiographies would decrease by 50%. Thus, implementation of the 0/1-h algorithm could reduce medical costs by 4,033,874 Japanese Yen (JPY) (9,447 JPY per patient) in Hospital B.Conclusion: The 0/1-h algorithm is efficient not only for risk stratification, but also for medical cost reduction.

Academic Significance and Societal Importance of the Research Achievements

胸痛を主訴に救急外来受診する患者には10人から15人に1人の確率で急性冠症候群が診断される。そのため安全面を考慮し緊急冠動脈造影検査目的での入院は少なくない。しかしながら救急対応は加算がつくため通常入院に比べ医療費がかかる。しかしながら救急外来で高感度トロポニンを来院時と1時間後に2度測定するだけで患者の層別化が容易にできる。結果、緊急入院を避けることができ、不必要な入院を減らせる可能性がある。本研究により、救急での時間と費用の削減効果が明示できれば、他の新規検査法の導入へのモデルとなる。

Research Products

• [Journal Article] Performance of the European Society of Cardiology 0/1-Hour, 0/2-Hour, and 0/3-Hour Algorithms for Rapid Triage of Acute Myocardial Infarction: An International Collaborative Meta-analysis. (2022)
  • Author(s): Chiang CH, Chiang CH,Pickering JW,Stoyanov KM, Chew, Neumann JT, Ojeda F,SrenseNA, Su K,Kavsak P, Worster A,Inoue K, Johannessen TR, Lee CC
  • Journal Title: Ann Intern Med Volume: 175 Issue: 1 Pages: 101-113
  • DOI: 10.7326/m21-1499
  • Peer Reviewed / Int'l Joint Research
• [Journal Article] Critical appraisal of the 2020 ESC guideline recommendations on diagnosis and risk assessment in patients with suspected non-ST-segment elevation acute coronary syndrome. (2021)
  • Author(s): Evangelos Giannitsis,Stefan Blankenberg,Robert H Christenson,Norbert Frey,Stephan von Haehling,Christian W Hamm,Kenji Inoue,Hugo A Katus,Chien-Chang Lee,James McCord,Martin Mckel,Jack Tan Wei Chieh,Marco Tubaro,Kai C Wollert,Kurt Huber
  • Journal Title: Clin Res Cardiol Volume: 110 Issue: 9 Pages: 1353-1368
  • DOI: 10.1007/s00392-021-01821-2
  • Peer Reviewed / Int'l Joint Research
• [Journal Article] Clinical evaluation of a new high-sensitivity cardiac troponin I assay for diagnosis and risk assessment of patients with suspected acute myocardial infarction (2021)
  • Author(s): M Shiozaki M, Inoue K*, Suwa S, Lee CC, Chiang SJ, Sato A, Shimizu M, Fukuda K, Hiki M, Kubota N, Tamura H, Fujiwara Y, Ouchi S, Miyazaki T, Hirano Y, Tanaka H, Sugita M, Nakazato Y, Sumiyoshi M, Daida H
  • Journal Title: Cardiology Volume: 146 Issue: 2 Pages: 172-178
  • DOI: 10.1159/000512185
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] High-sensitivity-cardiac troponin for accelerated diagnosis of acute myocardial infarction: A systematic review and meta-analysis. (2021)
  • Author(s): Lee CC, Huang SS, Yeo YH, Hou YT, Park JY, Inoue K, Hsu WT
  • Journal Title: Am J Emerg Med Volume: 7 Pages: 1402-1407
  • Peer Reviewed
• [Journal Article] The Asia-Pacific Society of Cardiology (APSC) Expert Committee Consensus Recommendations for Assessment of Suspected Acute Coronary Syndrome Using High-Sensitivity Cardiac Troponin T in the Emergency Department (2020)
  • Author(s): Tan WCJ,Inoue K, AbdelWareth L, Giannitsis E, Kasim S, Shiozaki, M, Aw TC, Cheng F, Dung HT, Li YH, Lim SH, Lukito AA, Than M, Chu FY, Devasia T, Lee CC, Phrommintikul A, Youn JC, Chew DP.
  • Journal Title: Circulation Journal Volume: 84 Issue: 2 Pages: 136-143
  • DOI: 10.1253/circj.CJ-19-0874
  • NAID: 130007789872
  • ISSN: 1346-9843, 1347-4820
  • Year and Date: 2020-01-24
  • Peer Reviewed
• [Journal Article] Implementing the European Society of Cardiology 0-h/1-h algorithm in patients presenting very early after chest pain. (2020)
  • Author(s): Shiozaki M, Inoue K*,Suwa S, Lee CC, Chiang SJ, Sato A, Shimizu M, Fukuda K, Hiki M, Kubota N, Tamura H, Fujiwara Y, Ouchi S, Miyazaki T, Hirano Y, Tanaka H, Sugita M, Nakazato Y, Sumiyoshi M, Daida H
  • Journal Title: Int J Cardiol Volume: 320 Pages: 1-6
  • DOI: 10.1016/j.ijcard.2020.07.037
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] High-sensitivity-cardiac;troponin for accelerated diagnosis of acute myocardial infarction: A systematic review and meta-analysis. (2019)
  • Author(s): Lee CC, Huang SS, Yeo YH, Hou YT, Park JY,Inoue K, Hsu WT
  • Journal Title: Am J Emerg Med. Volume: in press Issue: 7 Pages: 1402-1407
  • DOI: 10.1016/j.ajem.2019.11.035
  • Peer Reviewed / Int'l Joint Research
• [Presentation] Efficient Diagnosis and Reduced Medical Costs By The 0-hour/1-hour Algorithm For Patients With Suspected Non ST Elevation Acute Myocardial Infarction In The Emergency Department (2022)
  • Author(s): Shun Sasaki, Kenji Inoue, Masayuki Shiozaki, and Tohru Minamino
  • Organizer: American Heart Association’s annual Scientific Sessions
• [Presentation] Economic evaluation of the 0-hour/1-hour algorithm using high-sensitivity troponin T assay for patients with chest pain in the emergency department (2022)
  • Author(s): Shun Sasaki, Kenji Inoue, Masayuki Shiozaki, and Tohru Minamino
  • Organizer: 第86回日本循環器学会学術集会
• [Presentation] Economic evaluation of the 0-hour/1-hour algorithm using high-sensitivity troponin T assay for patients with chest pain in the emergency department (2022)
  • Author(s): Shun Sasaki, Kenji Inoue, Masayuki Shiozaki, and Tohru Minamino
  • Organizer: 第86回日本循環器学会学術集会
  • Int'l Joint Research
• [Presentation] One-year outcome of the rule-out group according to the 0-h /1-hour algorithm with suspected myocardial infarction in Asian countries. (2020)
  • Author(s): Masayuki Shiozaki, Kenji Inoue
  • Organizer: European society of cardiology congress 2020
• [Presentation] Novel Evidence in 0h/1h algo implementation in early Chest pain presenters in the ED (2020)
  • Author(s): Inoue K
  • Organizer: 2020 hs cTn Digital Masterclass
  • Invited
• [Presentation] A combination of HEART score and a 0-hour/1-hour algorithm for early and safe triage tool for patients in observe zone (2019)
  • Author(s): Masayuki Shiozaki, Kenji Inoue et al
  • Organizer: European society of cardiology congress 2019
  • Int'l Joint Research
• [Presentation] Prospective validation of the 2015 ESC 0-hour/1-hour algorithm using high-sensitivity cardiac troponin T in Asian counties. (2019)
  • Author(s): Masayuki Shiozaki, Kenji Inoue et al
  • Organizer: European society of cardiology congress 2019
  • Int'l Joint Research
• [Presentation] 高感度トロポニン（0/1 時間アルゴリズム）を用いた胸痛患者の診療体系の確立へ向けて (2019)
  • Author(s): 井上健司
  • Organizer: 第47回日本救急医学会総会・学術集会
• [Presentation] Prospective Validation Of The 2015 Esc 0-hour/1-hour Algorithm Using High-sensitivity Cardiac Troponin T In Asian Countries (2019)
  • Author(s): Masayuki Shiozaki, Kenji Inoue
  • Organizer: AHA(米国心臓病学会)2019
  • Int'l Joint Research
• [Presentation] Modified Framingham Risk Score enable to stratify observe group of the ESC high-sensitivity cardiac troponin 0 h/1 h-algorithm (2018)
  • Author(s): 塩崎正幸、井上健司
  • Organizer: 第82回日本循環器学会学術集会
• [Presentation] Establishment Of A New Score Incorporating The 0-Hour/1-Hour Algorithm Using High Sensitivity Cardiac Troponin T For Patients Presenting With Chest Pain In The Emergency Department. (2018)
  • Author(s): 塩崎正幸、井上健司
  • Organizer: 米国心臓病学会
• [Presentation] 高感度トロポニンを用いた胸痛患者のトリアージ、0-1時間アルゴリズムの有用性ついて (2018)
  • Author(s): 塩崎正幸、井上健司
  • Organizer: 第46回日本救急医学会総会・学術集会