Uncertainty and delay are common in the diagnosis of acute coronary syndromes (ACS). In the last 20 years, the need for faster, more accurate, and more cost-effective diagnosis gave rise to the concept of specialized treatment of patients with chest pain in emergency departments (EDs). The original strategy dedicated a separate section of the ED and a nursing staff to the task of rapid intervention in patients with acute myocardial infarction (MI) and triage of low-risk patients. Chest pain centers grew quickly in popularity but evolved with a variety of goals, staffing plans, diagnostic resources, and levels of commitment. There existing centers--the University of Cincinnati Heart ER, Brigham and Women's Hospital, and the Medical College of Virginia--have implemented chest pain strategies with the common aims of (1) screening for the entire spectrum of coronary artery disease, (2) avoiding unnecessary admissions, and (3) using multiple diagnostic modalities. Yet, they differ in the specifics of their approaches and diagnostic methods (e.g., echocardiography vs. treadmill vs. myocardial perfusion imaging). The safety and cost effectiveness of these centers are discussed.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/clc.4960221603

Chest pain emergency centers: improving acute myocardial infarction care.

Objectives: To analyze the current usage of transthoracic echocardiography (TTE) as a rapid, noninvasive tool in the early stratification of acute chest pain in c

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

Are Rapid Access Chest Pain Clinics effective and fair? Characteristics and outcomes of patient s from six centres

The focus of this symposium is Maryland's heart attack problem. The question is: Can the known evidence-based data on heart attacks be interpreted and applied in a systematic way that will unite efforts to reduce the significant heart attack deaths within the state? To determine this we need to go beyond what is currently being done and aim at a higher level of performance. Despite the medical advances in clot-dissolving therapies and minimally invasive surgeries, the acute prevention of heart attack death and damage has not been substantial. However, significant progress is possible. Better delivery systems, linking hospitals and communities, are needed. To accomplish this, emergency physicians and nurses, cardiologists, and paramedics need to form part of a team and have the support of the individual hospitals and the emergency medical system. Chest pain centers must function efficiently and cost effectively and bring about a community involvement that can significantly reduce heart attack deaths locally and, when combined with other hospitals, statewide.

R D Bahr

Papers

The early heart attack care strategy in the war against heart attack deaths utilizing the chest pain center approach in emergency departments.