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Background Acute coronary syndrome (ACS) accounts for approximately 2–6% of emergency department (ED) presentations and contributes at least 20% of the overall acute hospital admissions(1–3). Patients presenting with low-risk ACS may be suitable for remote monitoring(4) while awaiting an angiogram in the chest pain virtual ward(CPVW) thereby improving patient flow and resource utilisation. Purpose We aimed to assess outcomes for patients with low-risk ACS admitted in a district general hospital with a view to establishing an onboarding pathway for CPVW whilst ensuring safe monitoring without affecting the readmission rate or all-cause mortality. Methods We retrospectively analysed the Myocardial Ischaemia National Audit Project (MINAP) registry of from March 2022 to April 2023 for patients who presented to ED with a diagnosis of confirmed ACS. Patients were stratified into low-risk (GRACE score Results 1077 patients were coded as ACS diagnosis in ED. 561(52.1%) had a confirmed diagnosis of ACS. Data to allow stratification was available for 538 patients, included in the final analysis. 377(70.1%) were male with a mean age of 66.8 ± SD 13.1 years. A significant number of patients had other comorbidities, including hypertension (66.1%), diabetes (45.3%), hyperlipidaemia (51.3%), and previous history of IHD (46.5%). Total number of patients stratified into low-risk ACS was 55(10.2%), intermediate-to-high-risk group contained 483(89.8%) patients. The median total length of stay (LOS) for low-risk ACS patients was 4 days(IQR 2–7), waiting time to have an inpatient angiogram was 3 days(IQR 0–5), and discharge time post-angiogram was 1 day(IQR 0–2). 4 patients(7.3%) in the low-risk cohort required CCU admission for GTN infusion due to ongoing chest pain, among them 3 patients(5.5%) had an abnormal coronary angiogram. 5 patients(9.1%) in the low-risk cohort were readmitted due to chest pain post-angiogram and no patients had 30-days or 1-year all-cause mortality. The result depicts 51 patients from the low-risk cohort who would have been eligible for CPVW reducing the LOS from a median of 4 days to 1–2 days, this is a saving of 102–153 acute bed days per year. Assuming the cost of a bed day is £320 this equates to £32,640 - £48,960 cost saving without any adverse outcomes. Conclusion Our data suggests that there is a large cost saving with minimal risk in managing patients with low-risk ACS via a CPVW. This pathway of management is likely to have benefits in patient flow and resource utilisation in our district general hospital trust. Conflict of Interest Not applicable
Chakraborty et al. (Mon,) studied this question.