Chest pain evaluation units

Quin, Gareth

doi:10.1136/ewjm.173.6.403

Cited by 7 publications

(8 citation statements)

References 18 publications

(4 reference statements)

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“…No significant difference in the incidence of overall MACE was found, thus confirming the results of Quin. 16 In the present study, LOS was significantly shortened after implementation of a critical pathway, which is in concordance with previously published data. 17,18 Our LOS results, however, were still long compared with those reported in the literature (29 hours vs. 6 -14 hours, respectively).…”

Section: Discussionsupporting

confidence: 94%

“…Priorities in the CPU care processes are rapid and extended access to cardiac biomarker assays and exercise stress testing. 16 In our study, although point-of-care testing of cardiac biomarkers was implemented, around-the-clock exercise stress testing was not, because it was deemed to be economically unfeasible due to the relatively low number of admissions.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Implementation of the Guidelines for the Management of Patients With Chest Pain Through a Critical Pathway Approach Improves Length of Stay and Patient Satisfaction But Not Anxiety

Siebens¹,

Miljoen²,

Fieuws³

et al. 2010

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Implementation of the Guidelines for the Management of Patients With Chest Pain Through a Critical Pathway Approach Improves Length of Stay and Patient Satisfaction But Not Anxiety

Siebens¹,

Miljoen²,

Fieuws³

et al. 2010

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

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“…Eligibility for a potential CPU was estimated among low to moderate risk patients (see Results) with the following commonly used [3] exclusion criteria: tachy- (>110 bpm) or brady-arrhythmia (<40 bpm) of any sort, bilateral rales above lung bases (as a sign of heart failure), and inability to perform our standard bicycle ergometry stress test on the basis of muscle, joint or motor nerve problems.…”

Section: Methodsmentioning

confidence: 99%

“…In order to reduce unnecessary admission, to optimize disposition of admitted patients and to decrease cost, chest pain units (CPUs) with risk-based diagnostic protocols have been established in many hospitals, primarily in the United States [1,2]. These CPUs have been shown to increase the efficiency of patient evaluation with a quality similar to that of traditional EDs [3,4]. …”

Section: Introductionmentioning

confidence: 99%

Patients with suspected acute coronary syndrome in a university hospital emergency department: an observational study

et al. 2002

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Abstract

Background

It is widely considered that improved diagnostics in suspected acute coronary syndrome (ACS) are needed. To help clarify the current situation and the improvement potential, we analyzed characteristics, disposition and outcome among patients with suspected ACS at a university hospital emergency department (ED).

Methods

157 consecutive patients with symptoms of ACS were included at the ED during 10 days. Risk of ACS was estimated in the ED for each patient based on history, physical examination and ECG by assigning them to one of four risk categories; I (obvious myocardial infarction, MI), II (strong suspicion of ACS), III (vague suspicion of ACS), and IV (no suspicion of ACS).

Results

4, 17, 29 and 50% of the patients were allocated to risk categories I-IV respectively. 74 patients (47%) were hospitalized but only 19 (26%) had ACS as the discharge diagnose. In risk categories I-IV, ACS rates were 100, 37, 12 and 0%, respectively. Of those admitted without ACS, at least 37% could probably, given perfect ED diagnostics, have been immediately discharged. 83 patients were discharged from the ED, and among them there were no hospitalizations for ACS or cardiac mortality at 6 months. Only about three patients per 24 h were considered eligible for a potential ED chest pain unit.

Conclusions

Almost 75% of the patients hospitalized with suspected ACS did not have it, and some 40% of these patients could probably, given perfect immediate diagnostics, have been managed as outpatients. The potential for diagnostic improvement in the ED seems large.

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“…Early administration of anti-thrombotic therapy improves outcome in patients with acute coronary syndromes (ACS) [3][4][5][6][7]. However, most patients who present with chest pain do not have an ACS [8]. Novel and increasingly potent antithrombotic agents have recently been introduced into clinical practice for management of patients with ACS [3].…”

Section: Introductionmentioning

confidence: 99%

Impact of treatment algorithms on the prescribing of antithrombotic therapy in patients with suspected acute coronary syndrome – a prospective audit

Cameron

McCallum

Gardiner

et al. 2015

Brit J Clinical Pharma

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AIMSChest pain presentations are common although most patients do not have an acute coronary syndrome (ACS). We hypothesized that our local therapeutic guideline was leading to many low risk patients being inappropriately treated with potent anti-thrombotic therapy for ACS. METHODSWe conducted a prospective analysis of patients presenting with suspected ACS to the Western Infirmary Glasgow over a 2 month period between 6/10/13-3/11/13 and 5/4/14-2/5/14. We collated data on demographics, investigation, initial management and final diagnosis. Patients taking warfarin were excluded. We calculated sensitivity, specificity and receiver operating characteristic (ROC) curves for our local guideline, the SIGN guideline and a new guideline proposal. RESULTSWe studied 202 patients of whom 112 (55%) were male with mean (SD) age 60 (15) years. Full anti-thrombotic therapy for ACS was recommended in 91 patients (45%) according to the NHS GG&C guideline, 37 (18%) by the SIGN guideline and 30 (15%) by our new guideline proposal. The final diagnosis was ACS in 39 patients (19%). The current NHS GG&C guideline had a sensitivity of 80%, specificity 63% and AUROC 0.71 (95% CI 0.63, 0.80). The respective values were 62%, 92% and 0.77 (95% CI 0.67, 0.86) for the SIGN guideline and 54%, 94% and 0.74 (95% CI 0.64, 0.84) for our new proposed guideline. CONCLUSIONSOnly one-fifth of patients who present with chest pain or suspected ACS have ACS as their final diagnosis. Our new guideline proposal is highly specific and would minimize unnecessary administration of potent anti-thrombotic therapy to low risk patients.

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Chest pain evaluation units

Cited by 7 publications

References 18 publications

Implementation of the Guidelines for the Management of Patients With Chest Pain Through a Critical Pathway Approach Improves Length of Stay and Patient Satisfaction But Not Anxiety

Implementation of the Guidelines for the Management of Patients With Chest Pain Through a Critical Pathway Approach Improves Length of Stay and Patient Satisfaction But Not Anxiety

Patients with suspected acute coronary syndrome in a university hospital emergency department: an observational study

Impact of treatment algorithms on the prescribing of antithrombotic therapy in patients with suspected acute coronary syndrome – a prospective audit

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