Chest Pain Evaluation in the Emergency Department

Foy, Andrew; Filippone, Lisa M.

doi:10.1016/j.mcna.2015.02.010

Cited by 16 publications

(12 citation statements)

References 47 publications

(56 reference statements)

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“…Guidelines for the evaluation of patients admitted through the ED for chest pain to either an observation unit or the in‐hospital setting continue to evolve (Cook et al., ; Dave et al., ; Foy & Filioppone, ; Puelacher et al., ). Many centers “rule out” patients with chest pain for acute coronary syndromes (unstable angina or myocardial infarction) by serial EKGs and biomarkers, and when negative, discharge patients for early follow‐up.…”

Section: Discussionmentioning

confidence: 99%

“…It is estimated that more than 5 million patients present to the emergency department (ED) each year with complaints of chest discomfort (Ewy & Ornato, ). While there has been an increasing focus in trying to determine which patients can be safely discharged directly from the ED (Cook, Galperin‐Aizenberg, & Litt, ; Dave, Ferencic, Hoffmann, & Udelson, ; Foy & Filioppone, ; Puelacher, Hillinger, Wagener, & Muller, ), admission to observation units and inpatient telemetry for chest pain is still extremely prevalent.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness and outcomes of a nurse practitioner–run chest pain evaluation unit

Zhu

Islam

Bergmann

2016

Journal of the American Association of Nurse Practitioners

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Background Every year, more than 5 million patients seek medical care for chest pain. Objective The goal of this study was to evaluate test utilization and outcomes of a nurse practitioner (NP)‐based chest pain unit and compare results to data previously reported from our institution. Design, setting, and participants The records from 814 consecutive patients with chest pain admitted to the NP‐run unit were compared to the outcomes of 250 patients admitted to a separate hospitalist‐run unit at a New York City hospital. Results Forty‐four percent of patients in the NP unit underwent stress myocardial perfusion imaging (MPI) as the primary diagnostic test (compared to 22% in the hospitalist unit, p < .0001). The average length of stay was shorter for patients in the NP unit (2.7 ± 3.6 days compared to 3.9 ± 3.4 days, p < .0001). Additionally, the 90‐day readmission rate was less for patients in the NP unit (2.7% vs. 3.9%, p < .0006). Conclusions An NP‐run chest pain unit resulted in decreased length of stay and reduced readmission rates compared to a hospitalist‐based unit.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effectiveness and outcomes of a nurse practitioner–run chest pain evaluation unit

Zhu

Islam

Bergmann

2016

Journal of the American Association of Nurse Practitioners

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Section: Introductionmentioning

confidence: 99%

“…Chest pain is a key symptom of myocardial infarction (MI) and accounts for 5%–20% of all non-surgery emergency department (ED) contacts 1–3. Nonetheless, only 1 in 10 patients admitted to the ED with chest pain are diagnosed with MI 1–3. Rapid ‘rule-in’ and ‘rule-out’ of MI are essential to minimise unnecessary bed allocation and time to discharge for patients without MI and ensure prompt treatment for patients with MI 4…”

Section: Introductionmentioning

confidence: 99%

Rapid use of high-sensitive cardiac troponin I for ruling-in and ruling-out of acute myocardial infarction (RACING-MI): study protocol

Bang¹,

Hansen²,

Lauridsen³

et al. 2019

Open Heart

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IntroductionThe European Society of Cardiology has suggested an accelerated algorithm for ruling-in and ruling-out myocardial infarction (MI) with high-sensitive cardiac troponin (hs-cTn) measured at admission (0 hour) and after 1 hour (1 hour) as an alternative to standard measurements at 0 hour and 3 hours. However, the 0 hour/1 hour algorithm has only been tested in a limited amount of patient cohorts and not for all hs-cTn assays. Moreover, it is unknown if MI can be ruled-out faster than 1 hour. In this single-centre, clinical trial, we will investigate whether MI safely can be ruled-in or ruled-out after 30 min and 1 hour.Methods and analysisPatients with chest pain suggestive of MI admitted to the emergency department will be subjected to hs-cTn measurements at the following time points: 0 hour, 30 min, 1 hour and 3 hours. Chest pain characteristics will be recorded. In total, 1000 patients with all four blood samples will be included. The diagnostic algorithms will be derived based on the first 500 patients and validated in the subsequent 500 patients. The primary endpoint is the negative predictive value of the 0 hour/30 min and the 0 hour/1 hour algorithms. Secondary endpoints include positive predictive value, sensitivity and specificity. Results will be compared with the standard 0 hour/3 hour algorithm.Ethics and disseminationOral and written informed consent will be obtained from all patients. The trial is approved by The Regional Committee on Health Research Ethics and the Danish Data Protection Agency. Data will be disseminated and submitted to peer-reviewed scientific journals and meetings irrespective of study outcome.Trial registration numberNCT03634384

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“…The most frequent cause of chest pain is acute coronary syndrome (ACS), at rates of up to 45% 2 . In about 2% of cases, ACS is not correctly detected and patients are mistakenly discharged, 3 at a cost estimated to be higher than 6 billion dollars, 4 , 5 with missed diagnoses of ACS triggering increases in legal and medical expenses 6 …”

Section: Introductionmentioning

confidence: 99%

ANMCO-SIMEU Consensus Document: in-hospital management of patients presenting with chest pain

Zuin

Parato²,

Groff³

et al. 2017

European Heart Journal Supplements

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Chest pain is a common general practice presentation that requires careful diagnostic assessment because of its diverse and potentially serious causes. However, the evaluation of acute chest pain remains challenging, despite many new insights over the past two decades. The percentage of patients presenting to the emergency departments because of acute chest pain appears to be increasing. Nowadays, there are two essential chest pain-related issues: (i) the missed diagnoses of acute coronary syndromes with a poor short-term prognosis; and (ii) the increasing percentage of hospitalizations of low-risk cases. It is well known that hospitalization of a low-risk chest pain patient can lead to unnecessary tests and procedures, with an increasing trend of complications and burden of costs. Therefore, the significantly reduced financial resources of healthcare systems induce physicians and administrators to improve the efficiency of care protocols for patients with acute chest pain. Despite the efforts of the Scientific Societies in producing statements on this topic, in Italy there is still a significant difference between emergency physicians and cardiologists in managing patients with chest pain. For this reason, the aim of the present consensus document is double: first, to review the evidence-based efficacy and utility of various diagnostic tools, and, second, to delineate the critical pathways (describing key steps) that need to be implemented in order to standardize the management of chest pain patients, making a correct diagnosis and treatment as uniform as possible across the entire country.

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Chest Pain Evaluation in the Emergency Department

Cited by 16 publications

References 47 publications

Effectiveness and outcomes of a nurse practitioner–run chest pain evaluation unit

Effectiveness and outcomes of a nurse practitioner–run chest pain evaluation unit

Rapid use of high-sensitive cardiac troponin I for ruling-in and ruling-out of acute myocardial infarction (RACING-MI): study protocol

ANMCO-SIMEU Consensus Document: in-hospital management of patients presenting with chest pain

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