| Differences in diagnostic evaluation and clinical outcomes in the care of patients with chest pain based on admitting service: the benefits of a dedicated chest pain unit. | |
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MedLine Citation:
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PMID: 18371589 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Chest pain is one of the most common complaints of patients presenting at emergency departments. However, the most appropriate diagnostic evaluation for patients with chest pain but without acute coronary syndrome remains controversial, and differs greatly among institutions and physicians. At our institution, patients with chest pain can be admitted to an internist-run hospitalist service, a private attending service, or a cardiologist-run Chest Pain Unit. The goal of the present study was to compare the management and outcomes of patients admitted with chest pain based on admitting service. METHODS: The charts of 750 patients (250 consecutive patients per service) with a discharge diagnosis of chest pain were studied retrospectively. RESULTS: Patients admitted to the Chest Pain Unit were younger and had a lower prevalence of known coronary artery disease, hypertension, or diabetes, but a similar prevalence of other risk factors compared with the other groups. Sixty percent of the patients in the Chest Pain Unit underwent stress myocardial perfusion imaging as their primary diagnostic modality (vs 22% and 12% of patients in the hospitalist and private services, respectively; P < .001). In contrast, 35% of the patients admitted to the hospitalist service underwent rest echocardiography (vs 8% and 17% of patients in the Chest Pain Unit and private services, respectively; P < .001). Finally, 47% of the patients in the private service underwent coronary angiography as their primary diagnostic modality (vs 6% and 10% of patients in the Chest Pain Unit and hospitalist services, respectively; P < .001). The length of stay was shortest for patients in the Chest Pain Unit (1.4 +/- 1.2 days vs 3.9 +/- 3.4 days and 3.5 +/- 3.6 days in the hospitalist and private services, respectively; P < .001), even when corrected for patient age and number of risk factors. Readmission within 6 months was lowest for patients in the Chest Pain Unit (4.4% vs 17.6% and 15.2% in the hospitalist and private services, respectively; P < .001). CONCLUSIONS: The results of this study demonstrate that a highly protocolized chest pain unit, using myocardial perfusion imaging as primary diagnostic modality, results in a decreased length of stay and readmission rate. |
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Authors:
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Nir N Somekh; Maurice Rachko; Gregg Husk; Patricia Friedmann; Steven R Bergmann |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology Volume: 15 ISSN: 1532-6551 ISO Abbreviation: J Nucl Cardiol Publication Date: 2008 Mar-Apr |
Date Detail:
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Created Date: 2008-03-28 Completed Date: 2008-04-28 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9423534 Medline TA: J Nucl Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 186-92 Citation Subset: IM |
Affiliation:
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Department of Internal Medicine, Beth Israel Medical Center, New York, NY 10003, USA. nsomekh@chpnet.org |
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| MeSH Terms | |
Descriptor/Qualifier:
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Chest Pain
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epidemiology*,
radionuclide imaging* Comorbidity Coronary Artery Disease / epidemiology, radionuclide imaging Female Humans Incidence Length of Stay / statistics & numerical data* Male Middle Aged New York / epidemiology Patient Admission / statistics & numerical data* Patient Readmission / statistics & numerical data* Radionuclide Imaging / statistics & numerical data* Risk Assessment Risk Factors Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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