Self-referral to chest pain units: results of the German CPU-registry

Abstract

Background: Chest pain units (CPUs) are increasingly established in emergency cardiology services. With improved visibility of CPUs in the population, patients may refer themselves directly to these units, obviating emergency medical services (EMS). Little is known about characteristics and outcomes of self-referred patients, as compared with those referred by EMS. Therefore, we described self-referral patients enrolled in the CPU-registry of the German Cardiac Society and compared them with those referred by EMS. Methods and results: From 2008 until 2010, the prospective CPU-registry enrolled 11,581 consecutive patients. Of those 3789 (32.7%) were self-referrals (SRs), while 7792 (67.3%) were referred by EMS. SR-patients were significantly younger (63.6 vs. 70.1 years), had less prior myocardial infarction or coronary artery bypass surgery, but more previous percutaneous coronary interventions (PCIs). Acute coronary syndromes were diagnosed less frequently in the SRpatients (30.3 vs. 46.9%; p<0.0001). SR-patients showed ST-segment changes in their initial ECG in 19.6% of cases. EMSpatients underwent more coronary angiographies (60.0 vs. 47.5%; p<0.0001), while SR-patients underwent more stress tests (11.3 vs. 7.8%; p<0.001). PCI was performed in 32.6% of the EMS-and in 24.0% of the SR-group (p<0.0001).Conclusion: These data demonstrate that patients who contact a CPU as a self-referral are younger, less severely ill and have more non-coronary problems than those calling an emergency medical service. Nevertheless, 30% of self-referral patients had an acute coronary syndrome.

The Use of Echocardiography in Certified Chest Pain Units: Results from the German Chest Pain Unit Registry

“…Interestingly, and in contrast to self-referral, referral by an EMS turned out to be another independent variable for early TTE. As shown in a previous analysis by our group, a possible explanation may be that self-referrals are made by patients who are younger, less severely ill and are more likely to have noncoronary problems (ACS in about 30%) than those calling the EMS [28]. On the other hand, it might also be a hint that medical awareness within the CPU is higher if an EMS track has been started prior to arrival.…”

Chest Pain Centers

“…The analyses of the high portion of self-referrals currently started a discussion of providing an improved low-threshold access in the CPUs for patients' self-referral to allow better early detection of severe cardiac disorders. 22 However, beside the first positive impression of the standard-of-care in German CPUs, recent data also revealed that not all patients receive medical therapy following current guidelines and even if the outcome data are promising, the rate of rehospitalization remains high. At the moment, further studies are yet on their way focusing on guideline-adherence in German CPUs.…”

Die interdisziplinäre Notaufnahme im Zusammenspiel mit Chest Pain Units, Brustschmerzambulanzen und Cardiac Arrest Centern

“…Patienten, die sich fußläufig in der CPU vorstellten, waren in der Regel jünger, weniger schwer erkrankt und hatten eher nicht koronare Probleme als diejenigen, die einen Notfalldienst anriefen. Dennoch hatte eine hohe Anzahl (30 %) der Patienten, die sich selbst überwiesen, ein ACS [16]. Die Brustschmerzambulanz wird z.…”