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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 grou
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Contact: Nancy Jean
njean@lifespan.org
Lifespan
Source:Eurekalert  

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