The economic impact of acute coronary syndrome on length of stay: an analysis using the Healthcare Cost and Utilization Project (HCUP) databases

Abstract

Objective:

To assess the economic impact of initial and repeat hospitalizations associated with acute coronary syndrome (ACS) over 1 year (2009).

Design and methods:

National- and state-level data on length of stay (LOS) and related charges for ACS-associated hospital admissions were assessed using two Healthcare Utilization Project databases. The first, the Nationwide Inpatient Sample (NIS), provided clinical and resource use information from ∼8 million hospital stays, representing a 20% stratified sample of ∼40 million annual hospital stays in the US in 2009. The second, the State Inpatient Databases, provided 100% of inpatient data from nine states that included both patient age and linked information on multiple patient admissions within the same calendar year. For patients with repeat admissions, the LOS, primary diagnosis, and total charges between the first and subsequent admissions were evaluated. All patients ≥18 years of age with at least one diagnosis of ACS, defined using the International Classification of Diseases, 9th Revision, were included (code 410.xx [except 410.x2], 411.1x and 411.8x). Variables evaluated for each discharge included demographics, cardiovascular events and procedures, LOS, discharge status, and total charges.

Results:

The NIS reported 1,437,735 discharges for ACS in 2009. In this dataset, mean LOS for an initial ACS event was 5.56 days. Patients >65 years of age had the highest numbers of admissions; this group also had the most comorbidities. Approximately 40% of ACS patients with data on repeat visits had more than one admission, >70% of these within 2 months of the primary discharge. Mean charges were $71,336 for the first admission and $53,290 for the second admission.

Conclusion:

Despite a variety of new therapies to prevent ACS, it remains a common condition. Better therapies are called for if the clinical and cost burden of ACS is to be alleviated.

Keywords::

• Acute coronary syndrome
• Length of stay
• Re-admission
• Cost burden

Transparency

Declaration of funding

This research was supported by Janssen Scientific Affairs, LLC.

Declaration of financial/other relationships

J.C.L., C.C., and S.H.M. are employees of Janssen Scientific Affairs and have received stock or stock options from Johnson and Johnson. K.D. was an employee of Janssen Scientific Affairs at the time this study was conducted. O.S. is an employee of TriCore, Inc, to whom Janssen Scientific Affairs provided consulting fees for work on the design of this study and analysis of the data. JME Peer Reviewers on this manuscript have no relevant or other relationships to disclose.

Acknowledgments

The authors would like to acknowledge Ruth Sussman, PhD, who provided editorial support with funding from Janssen Scientific Affairs, LLC.

Previous presentation

Portions of this article were presented as a poster at the ASHP Midyear Clinical Meeting and Exhibition; December 2–6, 2012; Las Vegas, NV.