Outcomes of patients admitted for observation of chest pain

Archives of Internal Medicine
Srikanth C PenumetsaMichael B Rothberg

Abstract

Low-risk chest pain is a common cause of hospital admission; however, to our knowledge, there are no guidelines regarding the appropriate use of stress testing in such cases. We performed a retrospective cohort study of patients 21 years and older who were admitted to our tertiary care center with chest pain in 2007 and 2008. Using electronic records and chart review, we sought (1) to identify differences in the use of stress testing based on patient demographics and comorbidities, pretest probability of coronary artery disease, and house staff coverage and (2) to describe the results of stress testing and patient outcomes, including revascularization procedures and 30-day readmissions for myocardial infarction. Of 2107 patients, 1474 (69.9%) underwent stress tests, and the results were abnormal in 184 patients (12.5%). Within 30 days, 22 patients (11.6%) with abnormal test results underwent cardiac catheterization, 9 (4.7%) underwent revascularization, and 2 (1.1%) were readmitted for myocardial infarction. In a multivariable model, stress test ordering was positively associated with age younger than 70 years (RR [relative risk], 1.12; 95% CI, 1.02-1.23), private insurance (vs Medicare/Medicaid: RR, 1.19; 95% CI, 1.11-1.27), a...Continue Reading

Citations

Oct 9, 2013·Journal of Hospital Medicine : an Official Publication of the Society of Hospital Medicine·Jaya MallidiMichael B Rothberg
Nov 29, 2014·Journal of Hospital Medicine : an Official Publication of the Society of Hospital Medicine·Hacho B BohossianChristina Holcroft
Apr 16, 2014·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Anthony M Napoli
Dec 12, 2012·The American Journal of Cardiology·Shiny MathewkuttyMichael E Farkouh
Oct 4, 2016·The Journal of Emergency Medicine·Brit Long, Alex Koyfman
Jul 13, 2013·American Journal of Medical Quality : the Official Journal of the American College of Medical Quality·Andrew FoyMark Kozak
May 14, 2017·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Arash MokhtariUlf Ekelund
Mar 29, 2019·Internal and Emergency Medicine·Michael GavinPeter Zimetbaum
Dec 26, 2019·Emergency Medicine Journal : EMJ·Maia DorsettJerome R Hoffman
May 2, 2015·The Medical Journal of Australia·Louise CullenWilliam A Parsonage

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