The efficacy and safety of a chest pain protocol for short stay unit patients: A one year follow-up

Abstract

Background:

The Alfred Emergency Short Stay Unit initiated a chest pain protocol for patients presenting with chest pain to risk stratify for acute coronary syndrome (ACS). A 30-day follow-up of patients discharged with low-or-intermediate risk of ACS demonstrated no deaths or ACS.

Aims:

The purpose of this study was to evaluate the long-term safety of the chest pain protocol, a one year follow-up was undertaken.

Methods:

A questionnaire was designed for the one-year follow-up and it was administered via a telephone interview by emergency nurses to document adverse cardiac events and health care utilisation.

Results:

From 297 patients, 224 (75%) were contacted 12 months following discharge. There was one death from stroke (0.4%; 95% confidence interval (CI): 0.01–2.5%) and another from an unknown cause. Five patients had been diagnosed with atrial fibrillation (2.2%; 95% CI: 0.7–5.1%), two patients had an acute myocardial infarction (0.9%; 95% CI: 0.03–2.1%) and four were diagnosed with angina (1.8%; 95% CI: 0.9–3.2%). Nearly half (n=103, 46%; 95% CI: 39.5–52.5%) had returned to the emergency department (ED) for various conditions including 42 patients with further chest pain. Ninety-six patients (43%; 95% CI: 39.3–52.7%) had specialist referrals and 124 investigations were performed. Thirty-four patients had cardiology referrals (15%; 95% CI: 10.7–20.5%) and 25 patients had gastroenterology referrals (11%; 95% CI: 7.3–16.0%). Diagnostic cardiac tests were performed on 38 patients: coronary angiography (n=10), 24-hour Holter monitoring (n=17), 24-hour blood pressure (BP) monitoring (n=4), thallium scans (n=5), exercise stress test (n=1) and CT scan (n=1).

Conclusion:

Patients had a low risk of adverse events 12 months after discharge but substantial continuing health care utilization was observed. Complete assessment by health care professionals prior to discharge may help mitigate representations.

Keywords

Chest pain non-cardiac cause one-year follow-up emergency department

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