| Use of an accelerated chest pain assessment protocol in patients at intermediate risk of adverse cardiac events. | |
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MedLine Citation:
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PMID: 12697007 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To determine the feasibility, safety and effectiveness of a structured clinical pathway for stratification and management of patients presenting with chest pain and classified as having intermediate risk of adverse cardiac outcomes in the subsequent six months. DESIGN: Prospective clinical audit. PARTICIPANTS AND SETTING: 630 consecutive patients who presented to the emergency department of a metropolitan tertiary care hospital between January 2000 and June 2001 with chest pain and intermediate-risk features. INTERVENTION: Use of the Accelerated Chest Pain Assessment Protocol (ACPAP), as advocated by the "Management of unstable angina guidelines--2000" from the National Heart Foundation and the Cardiac Society of Australia and New Zealand. MAIN OUTCOME MEASURE: Adverse cardiac events during six-month follow-up. RESULTS: 409 patients (65%) were reclassified as low risk and discharged at a mean of 14 hours after assessment in the chest pain unit. None had missed myocardial infarctions, while three (1%) had cardiac events at six months (all elective revascularisation procedures, with no readmissions with acute coronary syndromes). Another 110 patients (17%) were reclassified as high risk, and 21 (19%) of these had cardiac events (mainly revascularisations) by six months. Patients who were unable to exercise or had non-diagnostic exercise stress test results (equivocal risk) had an intermediate cardiac event rate (8%). CONCLUSIONS: This study validates use of ACPAP. The protocol eliminated missed myocardial infarction; allowed early, safe discharge of low-risk patients; and led to early identification and management of high-risk patients. |
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Authors:
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Con N Aroney; Heather L Dunlevie; J H Nicholas Bett |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The Medical journal of Australia Volume: 178 ISSN: 0025-729X ISO Abbreviation: Med. J. Aust. Publication Date: 2003 Apr |
Date Detail:
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Created Date: 2003-04-16 Completed Date: 2003-06-17 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0400714 Medline TA: Med J Aust Country: Australia |
Other Details:
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Languages: eng Pagination: 370-4 Citation Subset: IM |
Affiliation:
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Cardiology Department, The Prince Charles Hospital, Rode Rd, Chermside, Queensland 4032, Australia. conar@bigpond.net.au |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Angina, Unstable / blood, diagnosis*, therapy Chest Pain / blood, diagnosis*, etiology Creatine Kinase / blood, diagnostic use Critical Pathways Diagnosis, Differential Disease-Free Survival Electrocardiography Emergency Service, Hospital Exercise Test Feasibility Studies Female Humans Male Middle Aged Myocardial Infarction / blood, diagnosis*, therapy Predictive Value of Tests Program Evaluation Prospective Studies Risk Assessment / methods Risk Factors Treatment Outcome Triage / methods* Troponin I / blood, diagnostic use |
| Chemical | |
Reg. No./Substance:
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0/Troponin I; EC 2.7.3.2/Creatine Kinase |
| Comments/Corrections | |
Comment In:
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Med J Aust. 2003 Apr 21;178(8):364-5
[PMID:
12697004
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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