Does Hospital Admission/Observation for Chest Pain Improve Patient Outcomes after Emergency Department Evaluation for Suspected Acute Coronary Syndrome?
Background Chest pain is the top reason for hospitalization/observation in the USA, but it is unclear if this strategy improves patient outcomes. Objective The objective of this study was to compare 30-day outcomes for patients admitted versus discharged after a negative emergency department (ED) ev...
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| Veröffentlicht in: | Journal of general internal medicine : JGIM 2022-03, Vol.37 (4), p.745-752 |
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| creator | Sharp, Adam L. Kawatkar, Aniket A. Baecker, Aileen S. Redberg, Rita F. Lee, Ming-Sum Ferencik, Maros Wu, Yi-Lin Shen, Ernest Zheng, Chengyi Park, Stacy Goodacre, Steve Thokala, Praveen Sun, Benjamin C. |
| description | Background
Chest pain is the top reason for hospitalization/observation in the USA, but it is unclear if this strategy improves patient outcomes.
Objective
The objective of this study was to compare 30-day outcomes for patients admitted versus discharged after a negative emergency department (ED) evaluation for suspected acute coronary syndrome.
Design
A retrospective, multi-site, cohort study of adult encounters with chest pain presenting to one of 13 Kaiser Permanente Southern California EDs between January 1, 2015, and December 1, 2017. Instrumental variable analysis was used to mitigate potential confounding by unobserved factors.
Patients
All adult patients presenting to an ED with chest pain, in whom an acute myocardial infarction was not diagnosed in the ED, were included.
Main Measures
The primary outcome was 30-day acute myocardial infarction or all-cause mortality, and secondary outcomes included 30-day revascularization and major adverse cardiac events.
Key Results
In total, 77,652 patient encounters were included in the study (
n
=11,026 admitted, 14.2%). Three hundred twenty-two (0.4%) had an acute myocardial infarction (
n
=193, 0.2%) or death (
n
=137, 0.2%) within 30 days of ED visit (1.5% hospitalized versus 0.2% discharged). Very few (0.3%) patients underwent coronary revascularization within 30 days (0.7% hospitalized versus 0.2% discharged). Instrumental variable analysis found no adjusted differences in 30-day patient outcomes between the hospitalized cohort and those discharged (risk reduction 0.002, 95% CI −0.002 to 0.007). Similarly, there were no differences in coronary revascularization (risk reduction 0.003, 95% CI −0.002 to 0.007).
Conclusion
Among ED patients with chest pain not diagnosed with an acute myocardial infarction, risk of major adverse cardiac events is quite low, and there does not appear to be any benefit in 30-day outcomes for those admitted or observed in the hospital compared to those discharged with outpatient follow-up. |
| doi_str_mv | 10.1007/s11606-021-06841-2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8904710</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2528180568</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-10ed9687322af341ddec1cb08cce3f94f71180e425bccbc58135432e3e9050303</originalsourceid><addsrcrecordid>eNp9kc1u1DAUhSMEokPhBVggS2zYhPo3djag0XRKK1UapMLacpybaarEDrYz0rwJj4unU1pgwcq27nePz72nKN4S_JFgLM8iIRWuSkxJiSvFSUmfFQsiqCgJr-XzYoGV4qWSjJ8Ur2K8w5gwStXL4oSxWklZi0Xx89xDRJc-Tn0yA1q2Yx9j793ZpokQdiblO-p8QKtbiAl9Nb1DV-MU_A7yI_XgEtrMyfoxy5guQUDrEcIWnN2jc5hMSOOBWe_MMD-p3cxxApugRUs7J0ArH7wzYY9u9q4NWezz6-JFZ4YIbx7O0-L7xfrb6rK83ny5Wi2vS8slTyXB0NZVnpFS0zFO2hYssQ1W1gLrat5JQhQGTkVjbWOFIkxwRoFBjQVmmJ0Wn46609yM0NpsNphBT6Efsx_tTa__rrj-Vm_9Tqsac0kOAh8eBIL_Mecl6bxCC8NgHPg5aiqoyhZEpTL6_h_0zs_B5fE0rZgUssaMZooeKRt8jAG6RzME60Pw-hi8zsHr--D1oendn2M8tvxOOgPsCMRcclsIT3__R_YXqt28XQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2637579032</pqid></control><display><type>article</type><title>Does Hospital Admission/Observation for Chest Pain Improve Patient Outcomes after Emergency Department Evaluation for Suspected Acute Coronary Syndrome?</title><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><source>SpringerLink Journals - AutoHoldings</source><creator>Sharp, Adam L. ; Kawatkar, Aniket A. ; Baecker, Aileen S. ; Redberg, Rita F. ; Lee, Ming-Sum ; Ferencik, Maros ; Wu, Yi-Lin ; Shen, Ernest ; Zheng, Chengyi ; Park, Stacy ; Goodacre, Steve ; Thokala, Praveen ; Sun, Benjamin C.</creator><creatorcontrib>Sharp, Adam L. ; Kawatkar, Aniket A. ; Baecker, Aileen S. ; Redberg, Rita F. ; Lee, Ming-Sum ; Ferencik, Maros ; Wu, Yi-Lin ; Shen, Ernest ; Zheng, Chengyi ; Park, Stacy ; Goodacre, Steve ; Thokala, Praveen ; Sun, Benjamin C.</creatorcontrib><description>Background
Chest pain is the top reason for hospitalization/observation in the USA, but it is unclear if this strategy improves patient outcomes.
Objective
The objective of this study was to compare 30-day outcomes for patients admitted versus discharged after a negative emergency department (ED) evaluation for suspected acute coronary syndrome.
Design
A retrospective, multi-site, cohort study of adult encounters with chest pain presenting to one of 13 Kaiser Permanente Southern California EDs between January 1, 2015, and December 1, 2017. Instrumental variable analysis was used to mitigate potential confounding by unobserved factors.
Patients
All adult patients presenting to an ED with chest pain, in whom an acute myocardial infarction was not diagnosed in the ED, were included.
Main Measures
The primary outcome was 30-day acute myocardial infarction or all-cause mortality, and secondary outcomes included 30-day revascularization and major adverse cardiac events.
Key Results
In total, 77,652 patient encounters were included in the study (
n
=11,026 admitted, 14.2%). Three hundred twenty-two (0.4%) had an acute myocardial infarction (
n
=193, 0.2%) or death (
n
=137, 0.2%) within 30 days of ED visit (1.5% hospitalized versus 0.2% discharged). Very few (0.3%) patients underwent coronary revascularization within 30 days (0.7% hospitalized versus 0.2% discharged). Instrumental variable analysis found no adjusted differences in 30-day patient outcomes between the hospitalized cohort and those discharged (risk reduction 0.002, 95% CI −0.002 to 0.007). Similarly, there were no differences in coronary revascularization (risk reduction 0.003, 95% CI −0.002 to 0.007).
Conclusion
Among ED patients with chest pain not diagnosed with an acute myocardial infarction, risk of major adverse cardiac events is quite low, and there does not appear to be any benefit in 30-day outcomes for those admitted or observed in the hospital compared to those discharged with outpatient follow-up.</description><identifier>ISSN: 0884-8734</identifier><identifier>ISSN: 1525-1497</identifier><identifier>EISSN: 1525-1497</identifier><identifier>DOI: 10.1007/s11606-021-06841-2</identifier><identifier>PMID: 33987795</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Acute Coronary Syndrome - complications ; Acute Coronary Syndrome - diagnosis ; Acute Coronary Syndrome - epidemiology ; Acute coronary syndromes ; Adult ; Chest ; Chest Pain - diagnosis ; Chest Pain - epidemiology ; Chest Pain - etiology ; Clinical outcomes ; Cohort Studies ; Emergency medical care ; Emergency medical services ; Emergency Service, Hospital ; Evaluation ; Heart ; Heart attacks ; Hospitalization ; Hospitals ; Humans ; Internal Medicine ; Medicine ; Medicine & Public Health ; Myocardial infarction ; Original Research ; Pain ; Patients ; Retrospective Studies ; Risk Assessment ; Risk management ; Risk reduction</subject><ispartof>Journal of general internal medicine : JGIM, 2022-03, Vol.37 (4), p.745-752</ispartof><rights>Society of General Internal Medicine 2021</rights><rights>2021. Society of General Internal Medicine.</rights><rights>Society of General Internal Medicine 2021.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-10ed9687322af341ddec1cb08cce3f94f71180e425bccbc58135432e3e9050303</citedby><cites>FETCH-LOGICAL-c474t-10ed9687322af341ddec1cb08cce3f94f71180e425bccbc58135432e3e9050303</cites><orcidid>0000-0002-6736-6184</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8904710/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8904710/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,724,777,781,882,27905,27906,41469,42538,51300,53772,53774</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33987795$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sharp, Adam L.</creatorcontrib><creatorcontrib>Kawatkar, Aniket A.</creatorcontrib><creatorcontrib>Baecker, Aileen S.</creatorcontrib><creatorcontrib>Redberg, Rita F.</creatorcontrib><creatorcontrib>Lee, Ming-Sum</creatorcontrib><creatorcontrib>Ferencik, Maros</creatorcontrib><creatorcontrib>Wu, Yi-Lin</creatorcontrib><creatorcontrib>Shen, Ernest</creatorcontrib><creatorcontrib>Zheng, Chengyi</creatorcontrib><creatorcontrib>Park, Stacy</creatorcontrib><creatorcontrib>Goodacre, Steve</creatorcontrib><creatorcontrib>Thokala, Praveen</creatorcontrib><creatorcontrib>Sun, Benjamin C.</creatorcontrib><title>Does Hospital Admission/Observation for Chest Pain Improve Patient Outcomes after Emergency Department Evaluation for Suspected Acute Coronary Syndrome?</title><title>Journal of general internal medicine : JGIM</title><addtitle>J GEN INTERN MED</addtitle><addtitle>J Gen Intern Med</addtitle><description>Background
Chest pain is the top reason for hospitalization/observation in the USA, but it is unclear if this strategy improves patient outcomes.
Objective
The objective of this study was to compare 30-day outcomes for patients admitted versus discharged after a negative emergency department (ED) evaluation for suspected acute coronary syndrome.
Design
A retrospective, multi-site, cohort study of adult encounters with chest pain presenting to one of 13 Kaiser Permanente Southern California EDs between January 1, 2015, and December 1, 2017. Instrumental variable analysis was used to mitigate potential confounding by unobserved factors.
Patients
All adult patients presenting to an ED with chest pain, in whom an acute myocardial infarction was not diagnosed in the ED, were included.
Main Measures
The primary outcome was 30-day acute myocardial infarction or all-cause mortality, and secondary outcomes included 30-day revascularization and major adverse cardiac events.
Key Results
In total, 77,652 patient encounters were included in the study (
n
=11,026 admitted, 14.2%). Three hundred twenty-two (0.4%) had an acute myocardial infarction (
n
=193, 0.2%) or death (
n
=137, 0.2%) within 30 days of ED visit (1.5% hospitalized versus 0.2% discharged). Very few (0.3%) patients underwent coronary revascularization within 30 days (0.7% hospitalized versus 0.2% discharged). Instrumental variable analysis found no adjusted differences in 30-day patient outcomes between the hospitalized cohort and those discharged (risk reduction 0.002, 95% CI −0.002 to 0.007). Similarly, there were no differences in coronary revascularization (risk reduction 0.003, 95% CI −0.002 to 0.007).
Conclusion
Among ED patients with chest pain not diagnosed with an acute myocardial infarction, risk of major adverse cardiac events is quite low, and there does not appear to be any benefit in 30-day outcomes for those admitted or observed in the hospital compared to those discharged with outpatient follow-up.</description><subject>Acute Coronary Syndrome - complications</subject><subject>Acute Coronary Syndrome - diagnosis</subject><subject>Acute Coronary Syndrome - epidemiology</subject><subject>Acute coronary syndromes</subject><subject>Adult</subject><subject>Chest</subject><subject>Chest Pain - diagnosis</subject><subject>Chest Pain - epidemiology</subject><subject>Chest Pain - etiology</subject><subject>Clinical outcomes</subject><subject>Cohort Studies</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Emergency Service, Hospital</subject><subject>Evaluation</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Myocardial infarction</subject><subject>Original Research</subject><subject>Pain</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk management</subject><subject>Risk reduction</subject><issn>0884-8734</issn><issn>1525-1497</issn><issn>1525-1497</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kc1u1DAUhSMEokPhBVggS2zYhPo3djag0XRKK1UapMLacpybaarEDrYz0rwJj4unU1pgwcq27nePz72nKN4S_JFgLM8iIRWuSkxJiSvFSUmfFQsiqCgJr-XzYoGV4qWSjJ8Ur2K8w5gwStXL4oSxWklZi0Xx89xDRJc-Tn0yA1q2Yx9j793ZpokQdiblO-p8QKtbiAl9Nb1DV-MU_A7yI_XgEtrMyfoxy5guQUDrEcIWnN2jc5hMSOOBWe_MMD-p3cxxApugRUs7J0ArH7wzYY9u9q4NWezz6-JFZ4YIbx7O0-L7xfrb6rK83ny5Wi2vS8slTyXB0NZVnpFS0zFO2hYssQ1W1gLrat5JQhQGTkVjbWOFIkxwRoFBjQVmmJ0Wn46609yM0NpsNphBT6Efsx_tTa__rrj-Vm_9Tqsac0kOAh8eBIL_Mecl6bxCC8NgHPg5aiqoyhZEpTL6_h_0zs_B5fE0rZgUssaMZooeKRt8jAG6RzME60Pw-hi8zsHr--D1oendn2M8tvxOOgPsCMRcclsIT3__R_YXqt28XQ</recordid><startdate>20220301</startdate><enddate>20220301</enddate><creator>Sharp, Adam L.</creator><creator>Kawatkar, Aniket A.</creator><creator>Baecker, Aileen S.</creator><creator>Redberg, Rita F.</creator><creator>Lee, Ming-Sum</creator><creator>Ferencik, Maros</creator><creator>Wu, Yi-Lin</creator><creator>Shen, Ernest</creator><creator>Zheng, Chengyi</creator><creator>Park, Stacy</creator><creator>Goodacre, Steve</creator><creator>Thokala, Praveen</creator><creator>Sun, Benjamin C.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7RV</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-6736-6184</orcidid></search><sort><creationdate>20220301</creationdate><title>Does Hospital Admission/Observation for Chest Pain Improve Patient Outcomes after Emergency Department Evaluation for Suspected Acute Coronary Syndrome?</title><author>Sharp, Adam L. ; Kawatkar, Aniket A. ; Baecker, Aileen S. ; Redberg, Rita F. ; Lee, Ming-Sum ; Ferencik, Maros ; Wu, Yi-Lin ; Shen, Ernest ; Zheng, Chengyi ; Park, Stacy ; Goodacre, Steve ; Thokala, Praveen ; Sun, Benjamin C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-10ed9687322af341ddec1cb08cce3f94f71180e425bccbc58135432e3e9050303</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Acute Coronary Syndrome - complications</topic><topic>Acute Coronary Syndrome - diagnosis</topic><topic>Acute Coronary Syndrome - epidemiology</topic><topic>Acute coronary syndromes</topic><topic>Adult</topic><topic>Chest</topic><topic>Chest Pain - diagnosis</topic><topic>Chest Pain - epidemiology</topic><topic>Chest Pain - etiology</topic><topic>Clinical outcomes</topic><topic>Cohort Studies</topic><topic>Emergency medical care</topic><topic>Emergency medical services</topic><topic>Emergency Service, Hospital</topic><topic>Evaluation</topic><topic>Heart</topic><topic>Heart attacks</topic><topic>Hospitalization</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Myocardial infarction</topic><topic>Original Research</topic><topic>Pain</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk management</topic><topic>Risk reduction</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sharp, Adam L.</creatorcontrib><creatorcontrib>Kawatkar, Aniket A.</creatorcontrib><creatorcontrib>Baecker, Aileen S.</creatorcontrib><creatorcontrib>Redberg, Rita F.</creatorcontrib><creatorcontrib>Lee, Ming-Sum</creatorcontrib><creatorcontrib>Ferencik, Maros</creatorcontrib><creatorcontrib>Wu, Yi-Lin</creatorcontrib><creatorcontrib>Shen, Ernest</creatorcontrib><creatorcontrib>Zheng, Chengyi</creatorcontrib><creatorcontrib>Park, Stacy</creatorcontrib><creatorcontrib>Goodacre, Steve</creatorcontrib><creatorcontrib>Thokala, Praveen</creatorcontrib><creatorcontrib>Sun, Benjamin C.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of general internal medicine : JGIM</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sharp, Adam L.</au><au>Kawatkar, Aniket A.</au><au>Baecker, Aileen S.</au><au>Redberg, Rita F.</au><au>Lee, Ming-Sum</au><au>Ferencik, Maros</au><au>Wu, Yi-Lin</au><au>Shen, Ernest</au><au>Zheng, Chengyi</au><au>Park, Stacy</au><au>Goodacre, Steve</au><au>Thokala, Praveen</au><au>Sun, Benjamin C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Does Hospital Admission/Observation for Chest Pain Improve Patient Outcomes after Emergency Department Evaluation for Suspected Acute Coronary Syndrome?</atitle><jtitle>Journal of general internal medicine : JGIM</jtitle><stitle>J GEN INTERN MED</stitle><addtitle>J Gen Intern Med</addtitle><date>2022-03-01</date><risdate>2022</risdate><volume>37</volume><issue>4</issue><spage>745</spage><epage>752</epage><pages>745-752</pages><issn>0884-8734</issn><issn>1525-1497</issn><eissn>1525-1497</eissn><abstract>Background
Chest pain is the top reason for hospitalization/observation in the USA, but it is unclear if this strategy improves patient outcomes.
Objective
The objective of this study was to compare 30-day outcomes for patients admitted versus discharged after a negative emergency department (ED) evaluation for suspected acute coronary syndrome.
Design
A retrospective, multi-site, cohort study of adult encounters with chest pain presenting to one of 13 Kaiser Permanente Southern California EDs between January 1, 2015, and December 1, 2017. Instrumental variable analysis was used to mitigate potential confounding by unobserved factors.
Patients
All adult patients presenting to an ED with chest pain, in whom an acute myocardial infarction was not diagnosed in the ED, were included.
Main Measures
The primary outcome was 30-day acute myocardial infarction or all-cause mortality, and secondary outcomes included 30-day revascularization and major adverse cardiac events.
Key Results
In total, 77,652 patient encounters were included in the study (
n
=11,026 admitted, 14.2%). Three hundred twenty-two (0.4%) had an acute myocardial infarction (
n
=193, 0.2%) or death (
n
=137, 0.2%) within 30 days of ED visit (1.5% hospitalized versus 0.2% discharged). Very few (0.3%) patients underwent coronary revascularization within 30 days (0.7% hospitalized versus 0.2% discharged). Instrumental variable analysis found no adjusted differences in 30-day patient outcomes between the hospitalized cohort and those discharged (risk reduction 0.002, 95% CI −0.002 to 0.007). Similarly, there were no differences in coronary revascularization (risk reduction 0.003, 95% CI −0.002 to 0.007).
Conclusion
Among ED patients with chest pain not diagnosed with an acute myocardial infarction, risk of major adverse cardiac events is quite low, and there does not appear to be any benefit in 30-day outcomes for those admitted or observed in the hospital compared to those discharged with outpatient follow-up.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>33987795</pmid><doi>10.1007/s11606-021-06841-2</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-6736-6184</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of general internal medicine : JGIM, 2022-03, Vol.37 (4), p.745-752 |
| issn | 0884-8734 1525-1497 1525-1497 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8904710 |
| source | MEDLINE; EZB-FREE-00999 freely available EZB journals; PubMed Central; Alma/SFX Local Collection; SpringerLink Journals - AutoHoldings |
| subjects | Acute Coronary Syndrome - complications Acute Coronary Syndrome - diagnosis Acute Coronary Syndrome - epidemiology Acute coronary syndromes Adult Chest Chest Pain - diagnosis Chest Pain - epidemiology Chest Pain - etiology Clinical outcomes Cohort Studies Emergency medical care Emergency medical services Emergency Service, Hospital Evaluation Heart Heart attacks Hospitalization Hospitals Humans Internal Medicine Medicine Medicine & Public Health Myocardial infarction Original Research Pain Patients Retrospective Studies Risk Assessment Risk management Risk reduction |
| title | Does Hospital Admission/Observation for Chest Pain Improve Patient Outcomes after Emergency Department Evaluation for Suspected Acute Coronary Syndrome? |
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