News | May 19, 2015

Many in Emergency Department for Chest Pain Do Not Need Admitting

Study of three hospitals finds life-threatening events in just 0.06 percent of cases

Wexner Medical Center, Michael Weinstock, chest pain, emergency, admitted

May 19, 2015 — Chest pain sends more than 7 million Americans to the emergency department each year. About half of them are admitted to the hospital for further observation, testing or treatment. Now, emergency medicine physicians at The Ohio State University Wexner Medical Center and Mount Carmel Health System believe that number can be significantly reduced.

Their study, published in JAMA Internal Medicine, finds a very low short-term risk for life-threatening cardiac events among patients with chest pain who have normal cardiac blood tests, vital signs and electrocardiograms.

“We wanted to determine the risk to help assess whether this population of patients could safely go home and do further outpatient testing within a day or two,” said Michael Weinstock, M.D., a professor of emergency medicine at The Ohio State University College of Medicine and chairman of the emergency department at Mt. Carmel St. Ann’s Hospital.

The researchers looked at data from 45,416 emergency department visits for chest pain at three Columbus-area hospitals between July 2008 and June 2013. Of those, 11,230 met the criteria for the study. Weinstock and colleagues looked for a primary outcome of life-threatening arrhythmia, inpatient heart attack, cardiac or respiratory arrest, or death. One of these bad outcomes occurred in four of the patients. Using a random sample of the medical records, that translates to a life-threatening event in 0.06 percent of these patients, or one in every 1,817.

“This data shows routine hospital admission is not the best strategy for this group. We tend to admit a lot of people with chest pain out of concern for missing a heart attack or some other life-ending irregularity,” Weinstock said. “To me, this says we can think more about what’s best for the patient long term. I’ve been having these conversations with my patients, and only one wanted to stay in the hospital. Most people want to go home and get tests done the next day.”

Additionally, Weinstock and his team believe current national guidelines to routinely admit, observe and test patients after a clean emergency department evaluation for chest pain should be reconsidered.

“We’d like to see more emergency medicine physicians having that bedside conversation to ensure the chest pain patient knows the risks and benefits of hospitalization compared to outpatient evaluation. We think continuing evaluation in an outpatient setting is not only safer for the patient, it’s a less costly approach for the health care system,” Weinstock said.

For more information: www.wexnermedical.osu.edu

Related Content

NIAID Scientists Illuminate Mechanism of Increased Cardiovascular Risks With HIV
News | Cardiac Diagnostics| September 14, 2017
September 14, 2017 — Scientists at the National Institutes of Health have expanded the understanding of how chronic i
Marijuana Associated With Three-Fold Risk of Death From Hypertension
News | Hypertension| September 14, 2017
Marijuana use is associated with a three-fold risk of death from hypertension, according to research published recently...
News | Cardiac Diagnostics| September 12, 2017
Contracting shingles, a reactivation of the chickenpox virus, increases a person’s risk of stroke and heart attack,...
Vascular screening for abdominal aortic aneurysm, peripheral artery disease and hypertension during the VIVA Study in Denmark

Vascular screening for abdominal aortic aneurysm, peripheral artery disease and hypertension during the VIVA Study. Photo credit: Lisbeth Hasager Justesen, Viborg Hospital.

News | Cardiac Diagnostics| September 12, 2017
September 12, 2017 — A new screening program for vascular disease saves one life for every 169 men assessed, accordin
PURE study may cause revision of fat intake guidelines for cardiology.
Feature | ESC| September 07, 2017
September 7, 2017 — Researchers at the European Society of Cardiology (ESC) Congress called for a reconsideration of
Florida Medical Center First in State to Offer High Sensitive STAT Blood Test
News | Blood Testing| September 07, 2017
In July, The Heart Institute at Florida Medical Center became the first hospital in the state of Florida to offer the U...
Heart Failure Patients, Clinicians Have Differing Perceptions of Risk Level
News | Heart Failure| September 06, 2017
September 6, 2017 — Physicians identified a majority of patients with advanced...
Advances in FFR, FFR-CT, was the most popular cardiology story in August 2017.

The most popular article in August was about advances in fractional flow reserve (FFR) technologies. The image shows Philips' new version of its iFR system that displays hemodynamic pressure drop points in an overlay on live angiographic images, matching up the iFR readings with corresponding lesions.

Feature | September 01, 2017 | Dave Fornell
September 1, 2017 — Here is the list of the most popular articles and videos on the Diagnostic and Interventional Car
Sponsored Content | Videos | Cardiovascular Ultrasound| August 30, 2017
This video educational session, provided in partnership with the American Society of Echocardiography (ASE), is title
HeartSciences Announces CE Mark and European Launch of MyoVista High Sensitivity ECG

Just as a Doppler radar color image shows the energy of a storm, MyoVista provides physicians a detailed visual image of the energy distribution during the cardiac cycle.

News | ECG| August 22, 2017
HeartSciences announced the European launch of the MyoVista high sensitivity electrocardiograph (hsECG) Testing Device...
Overlay Init