A cohort study of chest pain patients discharged from the emergency department for early outpatient treadmill exercise stress testing

Abstract

Outpatient treadmill EST an average of 10 days post-discharge from emergency with chest pain did not result in adverse events despite reasonably high positive stress test rates. Consensus-based recommendations for inpatient testing or outpatient testing within 72 h of discharge should be reviewed in light of these data.

Performance of an outpatient stress testing protocol for low risk chest pain patients presenting to the emergency department

“…In a smaller study in a similar population, Milano et al had similar findings, with 42% of patients returning for testing, but only 6% within 72 h [4]. Studies of patients with insurance, or in other countries, have had more success [5][6][7]. The yield of stress testing in our low risk population was low, but in line with other studies, which have shown that the incidence of coronary disease in low risk patients presenting to the ED is typically 1.5-2.5% [8,9].…”

What is the Yield of Testing for Coronary Artery Disease after an Emergency Department Attendance with Chest Pain?

“…and procedures. Since the guidelines were published a small body of evidence has challenged the need for routine testing showing adverse event rate <1% and low rates of identification of clinically relevant CAD [6][7][8]. Some authors have suggested clinical characteristics for the identification of very low risk groups including age and absence of known CAD [9,10].…”

“…In the Australian context Paoloni et al [8] retrospectively studied patients referred from ED for exercise stress testing.…”

Utility of Routine Exercise Stress Testing among Intermediate Risk Chest Pain Patients Attending an Emergency Department

“…Alternatively, referral of patients to outpatient chest pain clinics may prove to be efficient and cost effective with studies finding that physician judgment alone results in 50% of patients not undergoing EST [18]. Outpatient stress testing up to 14 days after discharge from ED has been found to have no adverse patient outcomes, even in patients who were ultimately found to have major CAD [19].…”