Physician discretion is safe and may lower stress test utilization in emergency department chest pain unit patients

Critical Pathways in Cardiology
Anthony M NapoliFrantz J Gibbs

Abstract

Chest pain unit (CPU) observation with defined stress utilization protocols is a common management option for low-risk emergency department patients. We sought to evaluate the safety of a joint emergency medicine and cardiology staffed CPU. Prospective observational trial of consecutive patients admitted to an emergency department CPU was conducted. A standard 6-hour observation protocol was followed by cardiology consultation and stress utilization largely at their discretion. Included patients were at low/intermediate risk by the American Heart Association, had nondiagnostic electrocardiograms, and a normal initial troponin. Excluded patients were those with an acute comorbidity, age >75, and a history of coronary artery disease, or had a coexistent problem restricting 24-hour observation. Primary outcome was 30-day major adverse cardiovascular events-defined as death, nonfatal acute myocardial infarction, revascularization, or out-of-hospital cardiac arrest. A total of 1063 patients were enrolled over 8 months. The mean age of the patients was 52.8 ± 11.8 years, and 51% (95% confidence interval [CI], 48-54) were female. The mean thrombolysis in myocardial infarction and Diamond & Forrester scores were 0.6% (95% CI, 0.51-0.62...Continue Reading

References

Jun 14, 1979·The New England Journal of Medicine·G A Diamond, J S Forrester
Nov 10, 2005·Cardiology Clinics·Ezra A AmsterdamSamuel D Turnipseed
Nov 23, 2006·Annals of Emergency Medicine·Michael J SchullTherese A Stukel
Jun 22, 2007·Emergency Medicine Journal : EMJ·Jane ArnoldUNKNOWN ESCAPE Research Team

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Citations

Nov 28, 2012·Clinics in Geriatric Medicine·Mark G MoseleyJeffrey M Caterino
Apr 16, 2014·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Anthony M Napoli
Oct 1, 2016·The American Journal of Emergency Medicine·Troy MadsenKurt Bernhisel
May 29, 2014·European Journal of Cardiovascular Nursing : Journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology·Geraldine LeePeter Cameron
Mar 29, 2019·Internal and Emergency Medicine·Michael GavinPeter Zimetbaum
Nov 15, 2014·Critical Pathways in Cardiology·Anthony M NapoliAlyson McGregor
Feb 16, 2013·Critical Pathways in Cardiology·Anthony M NapoliBethany Desroches
Nov 19, 2013·Critical Pathways in Cardiology·Anthony M NapoliJing Wang
Apr 1, 2021·Journal of the American Heart Association·Dustin G MarkUNKNOWN Kaiser Permanente CREST Network Investigators

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