A Critical Pathway for Patients With Acute Chest Pain and Low Risk for Short-Term Adverse Cardiac Events: Role of Outpatient Stress Testing

Meyer, Mary C.; Mooney, Robert P.; Sekera, Anna K.

doi:10.1016/j.annemergmed.2005.10.010

Cited by 56 publications

(40 citation statements)

References 32 publications

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“…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].…”

supporting

confidence: 56%

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

Balderston

Aurora

Kontos

et al. 2017

The American Journal of Emergency Medicine

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supporting

confidence: 56%

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

Balderston

Aurora

Kontos

et al. 2017

The American Journal of Emergency Medicine

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“…Although in high risk patients with non ST-elevation ACS (determined by the presence of a new or presumably new ST-depression or elevation of cardiac serum markers of myocardial injury) a coronary angiography is recommended [12,38], a recent study was unable to demonstrate the superiority of an early invasive strategy over a selectively invasive strategy in patients with Acute Coronary Syndromes without ST-segment elevation and troponin T release [39]. Additionally, it has been suggested that low risk patients studied for ACHP could receive outpatient STS [12,40]; in this setting, STS is useful to confirm the diagnosis of coronary artery disease and to predict the mediumand long-term risk for subsequent coronary events [11]. In the case of significant ischaemia, a coronary angiography and subsequent revascularization is recommended [12,13].…”

Section: Clinical Relevancementioning

confidence: 97%

Relationship between the QTc interval at hospital admission and the severity of the underlying ischaemia in low and intermediate risk people studied for acute chest pain

Jiménez‐Candil

Diego

González

et al. 2008

International Journal of Cardiology

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“…This underscores the importance that this population be investigated promptly with an exercise stress test or other modalities. 5 In Canada, the approach to arranging an exercise stress test is location dependent and is typically arranged by the family physician (FP) following discharge from the ED, but can also be arranged by ED staff at the time of discharge. It is not known which route offers the highest compliance rate, nor are the reasons known for noncompliance in this population.…”

Section: Introductionmentioning

confidence: 99%

Emergency department patient compliance with follow-up for outpatient exercise stress testing: a randomized controlled trial

Richards

Meshkat

Chu

et al. 2007

CJEM

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Introduction:Numerous patients are assessed in the emergency department (ED) for chest pain suggestive of acute coronary syndrome (ACS) and subsequently discharged if found to be at low risk. Exercise stress testing is frequently advised as a follow-up investigation for low-risk patients; however, compliance with such recommendations is poorly understood. We sought to determine if compliance with follow-up for exercise stress testing is higher in patients for whom the investigation is ordered at the time of ED discharge, compared with patients who are advised to arrange testing through their family physician (FP). Methods: Low-risk chest pain patients being discharged from the ED for outpatient exercise stress test and FP follow-up were randomized into 2 groups. ED staff ordered an exercise stress test for the intervention group, and the control group was advised to contact their FP to arrange testing. The primary outcome was completion of an exercise stress test at 30 days, confirmed through both patient contact and stress test results. Patients were unaware that our primary interest was their compliance with the exercise stress testing recommendations. Results: Two-hundred and thirty-one patients were enrolled and baseline characteristics were similar between the 2 groups. Completion of an exercise stress test at 30 days occurred in 87 out of 120 (72.5%) patients in the intervention group and 60 out of 107 (56.1%) patients in the control group. The difference in compliance rates (16.4%) between the 2 groups was statistically significant (χ 2 = 6.69, p < 0.001) with a relative risk of 1.29 (95% confidence interval 1.18-1.40), and the results remained significant after a "worst case" sensitivity analysis involving 4 control group cases lost to follow-up. When subjects were contacted by telephone 30 days after the ED visit, 60% of those who were noncompliant patients felt they did not have a heart problem and that further testing was unnecessary. Conclusion: When ED staff order an outpatient exercise stress test following investigation for potential ACS, patients are more likely to complete the test if it is booked for them before ED discharge. After discharge, many low-risk chest pain patients feel they are not at risk and do not return to their ORIGINAL RESEARCH • RECHERCHE ORIGINALE

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A Critical Pathway for Patients With Acute Chest Pain and Low Risk for Short-Term Adverse Cardiac Events: Role of Outpatient Stress Testing

Cited by 56 publications

References 32 publications

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

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

Relationship between the QTc interval at hospital admission and the severity of the underlying ischaemia in low and intermediate risk people studied for acute chest pain

Emergency department patient compliance with follow-up for outpatient exercise stress testing: a randomized controlled trial

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