{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:30:32Z","timestamp":1753893032926,"version":"3.41.2"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T00:00:00Z","timestamp":1742256000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>We estimated the average direct cost per Acute Coronary Syndromes (ACS) in-patient episodes by diagnosis, namely ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), unstable angina (UA), and undetermined AMI (Acute Myocardial Infarction). We also analyzed the changes in direct costs over time between 2002 and 2022, and the total direct economic burden of ACS hospitalizations for the Portuguese National Health Service (NHS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used the Portuguese Registry of Acute Coronary Syndromes (61,440 ACS hospitalizations), a cohort of people with ACS, recruited and followed from first hospitalization. A direct cost analysis was conducted. As resources, we considered health professional working hours, non-medical resources used during in-patient stays, laboratory and diagnostic tests, interventional cardiology procedures, pharmaceuticals, hospitalization-related complications, rehabilitation services, and death costs. A multivariate analysis was performed to identify the main cost determinants.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The average cost per ACS patient from 2002 to 2022 was 6,280.79 \u20ac. A significantly higher average cost was observed among patients diagnosed with STEMI of 3,853.26\u20ac (95% confidence interval [CI] 3,690.87 to 4,015.65\u20ac), among NSTEMI patients of 1,308.91 \u20ac (95% CI 1,173.52 \u20ac to 1,444.30 \u20ac), and among patients who died during the hospitalization of 12,017.64\u20ac (95% CI 11,232.21 \u20ac to 12,803.08 \u20ac). Over time, cost trends fluctuated, increasing until 2011 and then gradually decreasing until 2022, apart from 2020. Considering the total universe of 294,307 ACS-hospitalizations, the Portuguese NHS incurred a direct economic burden of 1,831 million euros over the complete period, with total annual costs averaging 87,203,851 \u20ac, representing on average 0.93% of the NHS annual health expenditure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>ACS represent a significant direct cost and economic burden for the NHS.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1433307","type":"journal-article","created":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T06:58:31Z","timestamp":1742281111000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Direct economic burden of acute coronary syndromes in the Portuguese National Health Service\u2014facts and trends between 2002 and 2022"],"prefix":"10.3389","volume":"13","author":[{"given":"Francisco","family":"Madeira","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carla","family":"Martins","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susana","family":"Viegas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Teresa","family":"Tim\u00f3teo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F\u00e1tima","family":"Loureiro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julian","family":"Perelman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,3,18]]},"reference":[{"year":"2023","key":"ref1"},{"year":"2023","key":"ref2"},{"year":"2023","key":"ref3"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1016\/j.jjcc.2022.07.003","article-title":"Treatment strategies of acute myocardial infarction: updates on revascularization, pharmacological therapy, and beyond","volume":"81","author":"Saito","year":"2023","journal-title":"J Cardiol"},{"year":"2023","key":"ref5"},{"year":"2020","key":"ref6"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e32","DOI":"10.1161\/CIR.0000000000001112","article-title":"Management of Acute Coronary Syndrome in the older adult population: a scientific statement from the American Heart Association","volume":"147","author":"Damluji","year":"2023","journal-title":"Circulation"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1016\/j.rce.2011.07.007","article-title":"Morbimortalidad y consumo de recursos asociados tras s\u00edndrome coronario agudo en una poblaci\u00f3n espa\u00f1ola","volume":"211","author":"Sicras-Mainar","year":"2011","journal-title":"Rev Clin Esp"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1090","DOI":"10.1177\/2047487313483608","article-title":"Direct healthcare costs and resource consumption after acute coronary syndrome: a real-life analysis of an Italian subpopulation","volume":"21","author":"Roggeri","year":"2014","journal-title":"Eur J Prev Cardiol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1097\/HPC.0b013e3182a78c06","article-title":"Resource consumption and healthcare costs of acute coronary syndrome: a retrospective observational administrative database analysis","volume":"12","author":"Roggeri","year":"2013","journal-title":"Crit Pathw Cardiol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1093\/ehjqcco\/qcw019","article-title":"Long-term resource use patterns and healthcare costs after myocardial infarction in a clinical practice setting: results from a contemporary nationwide registry study","volume":"2","author":"Janzon","year":"2016","journal-title":"Eur Heart J Qual Care Clin Outcomes"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1298","DOI":"10.1016\/j.cjca.2018.05.022","article-title":"Resource use and burden of hospitalization, outpatient, physician, and drug costs in short-and long-term care after acute myocardial infarction","volume":"34","author":"Tran","year":"2018","journal-title":"Can J Cardiol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1016\/j.amjms.2020.02.004","article-title":"Estimating the economic burden of acute myocardial infarction in the US: 12 year National Data","volume":"359","author":"Bishu","year":"2020","journal-title":"Am J Med Sci"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1016\/j.repc.2019.09.010","article-title":"Indirect costs of myocardial infarction in Portugal","volume":"39","author":"Tim\u00f3teo","year":"2020","journal-title":"Rev Port Cardiol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"I","DOI":"10.1159\/000495740","article-title":"Revis\u00e3o das orienta\u00e7\u00f5es metodol\u00f3gicas de estudos de avalia\u00e7\u00e3o econ\u00f3mica de medicamentos em Portugal [Revising methodological guidelines for the economic evaluation of pharmaceuticals in Portugal]. Port","volume":"36","author":"Pereira","year":"2019","journal-title":"J Public Health"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1016\/j.repc.2017.07.016","article-title":"Portuguese registry of acute coronary syndromes (pro ACS): 15 years of a continuous and prospective registry","volume":"37","author":"Tim\u00f3teo","year":"2018","journal-title":"Rev Port Cardiol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1016\/j.repce.2017.07.011","article-title":"Portuguese registry of acute coronary syndromes (pro ACS): 15 years of a continuous and prospective registry","volume":"37","author":"Tim\u00f3teo","year":"2018","journal-title":"Rev Portuguesa Cardiol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1186\/s12872-018-0859-4","article-title":"Predictors of high-cost hospitalization in the treatment of acute coronary syndrome in Asia: findings from EPICOR Asia","volume":"18","author":"Jan","year":"2018","journal-title":"BMC Cardiovasc Disord"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"13","DOI":"10.2147\/VHRM.S94026","article-title":"The cost of inpatient death associated with acute coronary syndrome","volume":"12","author":"Page","year":"2016","journal-title":"Vasc Health Risk Manag"},{"year":"2023","key":"ref20"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"e029252","DOI":"10.1161\/JAHA.122.029252","article-title":"In-Hospital Mortality and Treatment in Patients With Acute Coronary Syndrome With and Without Standard Modifiable Cardiovascular Risk Factors: Findings From the CCC-ACS Project","volume":"13","author":"Gong","year":"2024","journal-title":"J Am Heart Assoc."},{"key":"ref22","first-page":"8","article-title":"Acute and 1-Year Hospitalization Costs for Acute Myocardial Infarction Treated With Percutaneous Coronary Intervention: Results From the TRANSLATE-ACS Registry","author":"Cowper","year":"2019","journal-title":"J Am Heart Assoc."},{"key":"ref23","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1186\/s12872-018-0859-4","article-title":"Predictors of high-cost hospitalization in the treatment of acute coronary syndrome in Asia: findings from EPICOR Asia","volume":"18","author":"Jan","year":"2018","journal-title":"BMC Cardiovasc Disord."},{"key":"ref24","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1007\/s10557-007-6044-0","article-title":"Determinants of costs and the length of stay in acute coronary syndromes: a real life analysis of more than 10,000 patients","volume":"21","author":"Bramkamp","year":"2007","journal-title":"Cardiovasc Drugs Ther."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1002\/(SICI)1097-0258(19980115)17:1<59::AID-SIM733>3.0.CO;2-7","article-title":"Choosing among generalized linear models applied to medical data","volume":"17","author":"Lindsey","year":"1998","journal-title":"Stat Med"},{"year":"2023","key":"ref26"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1093\/eurheartj\/ehy394","article-title":"2018 ESC\/EACTS Guidelines on myocardial revascularization","volume":"40","author":"Neumann","year":"2019","journal-title":"Eur Heart J"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1016\/j.ahj.2023.01.003","article-title":"Trends in outcomes and resource utilization for acute myocardial infarction admissions during the COVID-19 pandemic","volume":"258","author":"Chouairi","year":"2023","journal-title":"Am Heart J"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"e2338707","DOI":"10.1001\/jamanetworkopen.2023.38707","article-title":"Sex disparities in management and outcomes among patients with acute coronary syndrome","volume":"6","author":"Zhou","year":"2023","journal-title":"JAMA Netw Open"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.hlc.2020.06.025","article-title":"Sex disparities in myocardial infarction: biology or Bias?","volume":"30","author":"Stehli","year":"2021","journal-title":"Heart Lung Circ"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13561-022-00401-y","article-title":"The clinical value and cost-effectiveness of treatments for patients with coronary artery disease","volume":"12","author":"Weiting","year":"2022","journal-title":"Heal Econ Rev"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"512","DOI":"10.21037\/atm.2020.01.20","article-title":"Cost of cardiovascular disease prevention: towards economic evaluations in prevention programs","volume":"8","author":"Santos","year":"2020","journal-title":"Ann Transl Med"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1460","DOI":"10.1093\/eurjpc\/zwae123","article-title":"Cost-effectiveness of Mediterranean diet and physical activity in secondary cardiovascular disease prevention: results from the UCC-SMART cohort study","volume":"31","author":"Bonekamp","year":"2024","journal-title":"Eur J Prev Cardiol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1186\/s12962-018-0108-9","article-title":"Primary and secondary prevention interventions for cardiovascular disease in low-income and middle-income countries: a systematic review of economic evaluations","volume":"16","author":"Aminde","year":"2018","journal-title":"Cost Effect Resour Allocat"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1596\/978-1-4648-0518-9_ch19","article-title":"Costs and cost-effectiveness of interventions and policies to prevent and treat cardiovascular and respiratory diseases","volume-title":"Disease control priorities, third edition (volume 5): Cardiovascular, respiratory, and related disorders","author":"Gaziano","year":"2017"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1161\/CIRCULATIONAHA.115.008721","article-title":"Resource effective strategies to prevent and treat cardiovascular disease","volume":"133","author":"Schwalm","year":"2016","journal-title":"Circulation"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1056\/NEJMp1206268","article-title":"The cost-effectiveness of environmental approaches to disease prevention","volume":"367","author":"Chokshi","year":"2012","journal-title":"N Engl J Med"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"642","DOI":"10.1038\/s41598-021-04634-5","article-title":"Improving smoking cessation after myocardial infarction by systematically implementing evidence-based treatment methods","volume":"12","author":"Leosdottir","year":"2022","journal-title":"Sci Rep"},{"key":"ref39","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1596\/978-1-4648-0518-9_ch8","article-title":"Ischemic heart disease: cost-effective acute management and secondary prevention","volume-title":"Disease control priorities, third edition (volume 5): Cardiovascular, respiratory, and related disorders","author":"Dugani","year":"2017"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/j.jval.2021.07.015","article-title":"Cost-effectiveness of Posthospital Management of Acute Coronary Syndrome: a real-world investigation from Italy","volume":"25","author":"Rea","year":"2022","journal-title":"Value Health"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"P71","DOI":"10.4244\/EIJV8SPA12","article-title":"Economic evidence of interventions for acute myocardial infarction: a review of the literature","volume":"8","author":"Callea","year":"2012","journal-title":"Euro Intervent"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1433307\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T06:58:34Z","timestamp":1742281114000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1433307\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,18]]},"references-count":41,"alternative-id":["10.3389\/fpubh.2025.1433307"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1433307","relation":{},"ISSN":["2296-2565"],"issn-type":[{"type":"electronic","value":"2296-2565"}],"subject":[],"published":{"date-parts":[[2025,3,18]]},"article-number":"1433307"}}