Navigation Links
ED chest pain units and physician discretion may lower stress test use
Date:3/26/2012

PROVIDENCE, R.I. Rhode Island Hospital (www.rhodeislandhospital.org) physicians report that managing chest pain patients within an emergency department chest pain unit by both emergency medicine staff and cardiologists is safe and effective and may lower the use of stress testing. A new study indicates that when patients were jointly managed and when stress testing was largely at the discretion of a cardiologist, stress testing use was lower and there was a low rate of 30-day major cardiac events. The study is published online in advance of print in Clinical Pathways in Cardiology.

Heart disease is the leading cause of death in the United States. Lead author Anthony Napoli, M.D., an emergency medicine physician and medical director of the Rhode Island Hospital chest pain unit, says that overall mortality has improved and advances have been made in the treatment of cardiovascular disease. However, the most efficient and effective management of patients with undifferentiated chest pain in the emergency department has remained elusive.

Napoli says, "There continue to be "miss rates" of two percent in diagnosing acute myocardial infarction (AMI) or unstable angina in patients discharged from the emergency department. Even patients with undifferentiated chest pain who are admitted to the hospital may still have significant adverse events within one year."

During the past decade, there has been a rise in chest pain units (CPUs) and protocols surrounding the management of patients for the treatment of undifferentiated chest pain. The CPUs have been shown to provide efficient and cost-effective care driven by guidelines. The protocols vary widely, but typically include some form of stress testing. These non-selective approaches are associated with relatively low rates of abnormal stress tests, ranging from seven to 14 percent. Even in very low-risk patient populations, some groups have recommended very liberal use of stress testing and evaluation by a cardiologist is often reserved for those patients with positive stress tests only. As a result, the lower rates of missed AMI and unstable angina are likely the result of liberal use of stress testing.

With this in mind, Napoli and his colleagues conducted an observational study within the Rhode Island Hospital emergency department, a Level I trauma center with a chest pain unit (CPU). Their goal was to determine whether selective use of stress testing in a CPU managed jointly by emergency physicians and cardiologists was associated with a low incidence of 30-day major adverse cardiac events while maintaining a low stress test utilization rate.

During an eight-month period, 1,063 patients were included in the study. Napoli says, "To our knowledge, this is one of the largest single center observational trials of 30-day adverse events of CPU patients to date. We found only 51 percent of the patients received a stress test, with very few adverse events."

Napoli adds, "We believe that patients who are seen for chest pain may benefit from the protocol that is used in the Rhode Island Hospital CPU, and this may lower the cost of care through more selective stress test utilization."


'/>"/>
Contact: Nancy Jean
njean@lifespan.org
Lifespan
Source:Eurekalert  

Related medicine news :

1. Tapping the brain orchestra
2. Rochesters Palliative Care Program achieves top national certification
3. US patent awarded for Rochesters pioneering HPV vaccine work
4. Sunken Chest Demands Prompt Evaluation, Expert Says
5. FDA funds Rochester researchers to give chronic and acute pain clinical trials a makeover
6. CHEST 2011: Embargoed studies highlight new lung cancer and COPD research
7. Rochester study: Age a big factor in prostate cancer deaths
8. Childrens Chest Pain Rarely Cause for Alarm: Study
9. How fair sanctions are orchestrated in the brain
10. Experts offer pointers for optimizing radiation dose in chest CT
11. Newsbriefs from the July issue of the journal Chest
Post Your Comments:
*Name:
*Comment:
*Email:
Related Image:
ED chest pain units and physician discretion may lower stress test use
(Date:5/28/2016)... of America (PRWEB) , ... May 28, 2016 , ... ... SuperCloset knows all too well the day to day issues, struggles and obstacles veterans’ ... The Helping Veterans Grow Project provides active or retired military veteran(s) with a ...
(Date:5/28/2016)... ... May 28, 2016 , ... After a year and a half of planning the ... extraordinary event. The Multiple Pathways of Recovery Conference was held May 2 -4, 2016 ... and the United Kingdom came together to explore the many pathways individuals use to get ...
(Date:5/27/2016)... ... May 27, 2016 , ... Southland Log Homes ... classic American timber frame barn kits, which can be found on its website at ... historic American barn plans, and they highlight the craftsmanship of timber post and beam ...
(Date:5/27/2016)... New York, NY (PRWEB) , ... May 27, 2016 , ... ... annual campaign returns for a third time to shed lights on the variety of ... resources and inspirational stories, “Nurse Appreciation” tackles why this career has gone from being ...
(Date:5/27/2016)... New York, NY (PRWEB) , ... May 27, ... ... caregivers to casual readers, this installment is bolstered by inspiring human-interest stories, courtesy ... trends and tech within the industry, from leading advocates, associations and industry leaders ...
Breaking Medicine News(10 mins):
(Date:5/24/2016)... --   , Study met ... cleansing and superiority in , Excellent ... of the ascending colon   , ... Norgine B.V. today announced new positive data from the phase III ... versus standard 2 litre PEG with ascorbate. The study met both ...
(Date:5/24/2016)... LAWRENCE, Mass. , May 24, 2016  NxStage ... medical technology company focused on advancing renal care, today ... Officer, plans to participate in the following schedule of ... will be made available at http://ir.nxstage.com/ . ... Jefferies Healthcare Conference NY, NY           Friday, ...
(Date:5/24/2016)... , May 24, 2016 ... the world , s first dual ... fistula intervention   OrbusNeich, a global company ... expanded its portfolio to include products to treat peripheral ... the company,s first entry devices for lower limb and ...
Breaking Medicine Technology: