Received care compared to ADP-guided care of patients admitted to hospital with chest pain of possible cardiac origin

Abstract

PurposeTo assess the extent to which accelerated diagnostic protocols (ADPs), compared to traditional care, identify patients presenting to emergency departments (EDs) with chest pain who are at low cardiac risk and eligible for early ED discharge.Patients and methodsRetrospective study of 290 patients admitted to hospital for further evaluation of chest pain following negative ED workup (no acute ischemic electrocardiogram [ECG] changes or elevation of initial serum troponin assay). Demographic data, serial ECG and troponin results, Thrombolysis in Myocardial Infarction (TIMI) score, cardiac investigations, and outcomes (confirmed acute coronary syndrome [ACS] at discharge and major adverse cardiac events [MACEs]) over 6 months of follow-up were analyzed. A validated ADP (ADAPT-ADP) was retrospectively applied to the cohort, and processes and outcomes of ADP-guided care were compared with those of care actually received.ResultsPatients had mean (±SD) TIMI score of 1.8 (±1.7); six (2.0%) patients were diagnosed with ACS at discharge. At 6 months, one patient (0.3%) re-presented with ACS and two (0.6%) died of non-coronary causes. The ADAPT-ADP defined 97 (33.4%) patients as being at low risk and eligible for early ED discharge, but who instead incurred mean hospital stay of 1.5 days, with 40.2% in telemetry beds, and 21.6% subject to non-invasive testing with only one positive result for coronary artery disease. None had a discharge diagnosis of ACS or developed MACE at 6 months.ConclusionCompared to traditional care, application of the ADAPT-ADP would have allowed one-third of chest pain patients with initially negative investigations in ED to have been safely discharged from ED.

Perspectives on Resolving Diagnostic Challenges between Myocardial Infarction and Takotsubo Cardiomyopathy Leveraging Artificial Intelligence

“…Timely and expeditious electrocardiographic (ECG) testing is essential for individuals presenting with chest pain. It is important to note that women may exhibit atypical symptoms, such as abdominal pain or dizziness, and elderly patients may present primarily with shortness of breath during a myocardial infarction (MI) episode [45][46][47]. The ECG is highly specific for MI (95% to 97%) but lacks sensitivity (approximately 30%).…”

Audit‐based measures of overuse of medical care in Australian hospital practice

“…For studies of management strategies (Table ), corresponding rates of overuse comprised: 14–74% of blood product infusions among patients with various conditions ( n = 3) 15–55% of older patients receiving at least one inappropriate medication ( n = 7) 34% of chronically prescribed medications of various classes among older patients ( n = 1) 99% of ondansetron prescriptions in patients with severe emesis ( n = 1) 63–90% of regular prescriptions for gastric acid suppressants in patients admitted to intensive care units ( n = 2) 34% of regular prescriptions of direct oral anticoagulants in patients with various conditions ( n = 1) 21% of antimicrobial prescriptions for patients with acute infections ( n = 1) 52% of prescriptions for inhaled corticosteroids in patients with mild chronic obstructive pulmonary disease ( n = 1) 55% of instances of high flow oxygen therapy administered to patients with chronic obstructive pulmonary disease ( n = 1) 33% of overnight admissions to medical assessment and planning unit for monitoring and evaluation relating to patients presenting to emergency department with undifferentiated chest pain and low coronary risk ( n = 1) 10–64% of end‐of‐life care admissions featuring the administration of futile interventions ( n = 3) …”