Abstract 13600: Patients Identified as Low Risk May Be Safely Discharged From the Emergency Department After Presentation With Chest Pain

• Published in: Circulation (New York, N.Y.) N.Y.), 2015-11, Vol.132 (Suppl_3 Suppl 3), p.A13600-A13600
• Main Authors: Adeola, Oluwaseun, Ruthmann, Nicholas, Boshard, Barbara, Geltman, Joshua, Ardhanari, Sivakumar, Dohrmann, Mary L
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.132.suppl_3.13600

BackgroundChest pain accounts for over 8 million visits to the emergency department (ED) annually in the United States. However, only a minority of these patients are eventually diagnosed with acute myocardial infarction.HypothesisA protocol may be safely utilized to identify and evaluate low risk patients upon presentation to the ED with chest pain.MethodsA prospective study at a large academic medical center evaluated the safety of a protocol to schedule outpatient stress testing and follow-up for low risk patients discharged from the ED after presenting with chest pain. Patients were low risk if they were pain-free in the ED, had negative cardiac enzymes, non-ischemic electrocardiogram and TIMI risk score < 1, or if a cardiologist deemed patient low risk for acute myocardial infarction. Selected patients were discharged from the ED and scheduled for stress testing within 1-3 business days. Patients with positive test results were evaluated by a cardiologist for medical management or coronary angiography as needed.ResultsA total of 1,735 patients were enrolled in the protocol. Of the 1,036 patients completing a follow-up stress test, only 6.4% (66/1,036) had an abnormal result. Forty-two of these 66 patients (63.6%) were either determined to be false positive by the cardiologist or underwent medical management. The remaining 24 (36.4%) had coronary angiography, of which only 20.8% (5/24) had significant coronary artery disease requiring percutaneous coronary intervention. All patients were followed for 30 days after their ED visit. During this period, 1.9% (33/1735) of patients returned to the ED per protocol, and 1% (18/1735) were admitted to the hospital for chest pain or other cardiovascular presentation. Only 3 patients (0.2%) had myocardial infarction. No mortality was recorded during this period. With this protocol, patients and insurers avoided over $16 million in professional and facility charges and over $3 million in payments. Estimated cost savings from reducing hospitalization in our patient population was about $3.77 million.ConclusionsOur data support that an outpatient evaluation protocol for low risk patients presenting to the ED with chest pain is safe, avoids unnecessary hospitalization and reduces healthcare cost.