Author + information
- Elad Asher,
- Nir Shlomo,
- Roy Beigel,
- Michael Naroditsky,
- Ronen Goldkorn,
- Orly Goitein,
- Ari Shamiss,
- Hanoch Hod,
- Haim Reuveni and
- Shlomi Matetzky
The diagnosis of acute coronary syndrome (ACS) in patients presenting to the emergency medicine department (EMD) with chest pain is challenging. Many of these patients are admitted to the Internal Medicine Departments for routine checkup (RC). Data from the current era with accelerated diagnostic protocol (ADP) using newer technology in the Chest Pain Unit (CPU) is lacking.
585 consecutive patients with low-moderate risk ACS were prospectively studied. 304 were admitted to the CPU and were evaluated by ADP and 292 underwent RC. All pts were prospectively followed for 90 days for major adverse cardiac events (MACE), defined as death, ACS and readmission. Admission and procedures costs were collected.
Patients admitted to RC were older and were more likely to have prior CAD. The length of stay was longer in the RC group. Nevertheless, only 19% of the RC patients had noninvasive diagnostic imaging testing compared with 98% of CPU patients. During the hospital course there were 5 cases of non ST elevation myocardial infarctions in the RC group and none in the CPU group (p=0.025). During the 90 days follow-up the RC group had more diagnostic imaging testing performed in the community compared with the CPU group [106 (38%) vs. 41 (13%), respectively, p<0.001)]. Moreover, readmission due to chest pain and ACS events rates were significantly higher in the RC group compare with the CPU group [24 (9%) vs. 8 (3%) for readmissions; 5 (2%) vs. 1 (0.3%) case for NSTEMI and 4 (1.5%) vs. 0 (0%) cases for UAP, respectively] with a total MACE of 33 (12%) vs. 9 (3%), respectively, p<0.001. Treatment in the CPU correlate with a reduction of ACS events within 90 days following discharge even after propensity score analysis [OR=0.13 (CI 95% 0.03-0.59)], as well as reduction in total cost per patient $2510 in the CPU vs. $2703 in the RC.
The treatment of chest pain patients in the CPU by ADP is efficient and may save time, resources and adverse cardiac events. The treatment quality, time length and costs are all in favor of the CPU compared with RC.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Chest Pain and MI: The Good, the Bad and the Readmission Rate
Abstract Category: 22. Performance Improvement
Presentation Number: 1132-273
- 2013 American College of Cardiology Foundation