Author + information
- Andrew Czarnecki,
- Alice Chong,
- Douglas S. Lee,
- Michael J. Schull,
- Jack V. Tu,
- Ching Lau,
- Michael E. Farkouh,
- David Pereg,
- Harindra C. Wijeysundera and
- Dennis T. Ko
Our objective was to assess the impact of physician follow-up on clinical outcomes after discharge from the emergency department (ED) in chest pain patients without established cardiovascular disease.
We performed an observational study in Ontario, Canada using population-based databases to identify consecutive chest pain patients that were seen and discharged from the ED between 2004 and 2010. Patients who were ≥ 50 years old without established cardiovascular disease were included. Adjusted outcomes using proportional hazard models, were compared based on follow-up by a cardiologist, primary care physician (PCP) or no follow-up, assigned within 30 days of the ED visit. The primary outcome was death or myocardial infarction (MI) at one-year.
We included 216,527 patients, of which, 11% had cardiologist, 60% had PCP and 29% had no-physician follow-up. The mean age was 64.2 ± 10.4 and 42% were male. The cardiology cohort had the highest rates of medication utilization, diagnostic testing and coronary revascularization. The rate of death or MI at one-year was 1.6% in the cardiology, 2.3% in the PCP and 2.1% in the no-physician group (p <0.001). The adjusted hazard ratio for death or MI was 0.79 (95% CI 0.71-0.88; p <0.001) in the cardiology group and 1.06 (95% CI 0.99-1.14; p = 0.122) in the PCP group, as compared to the no-physician group.
Cardiologist follow-up after ED visit with chest pain was associated with a substantial reduction in death and MI at one-year.
West, Room 3006
Sunday, March 10, 2013, 8:15 a.m.-8:30 a.m.
Session Title: Advancing the Cutting Edge of Cardiovascular Care: Recent Accomplishments and Future Goals
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 920-4
- 2013 American College of Cardiology Foundation