Journal ArticleDOI
A Clinical Trial of a Chest-Pain Observation Unit for Patients with Unstable Angina
Michael E. Farkouh,Peter A. Smars,Guy S. Reeder,Alan R. Zinsmeister,Roger W. Evans,Thomas D. Meloy,Stephen L. Kopecky,Marvin R. Allen,Thomas G. Allison,Raymond J. Gibbons,Sherine E. Gabriel +10 more
Reads0
Chats0
TLDR
A CPU located in the emergency department can be a safe, effective, and cost-saving means of ensuring that patients with unstable angina who are considered to be at intermediate risk for cardiovascular events receive appropriate care.Abstract:
Background Nearly half of patients hospitalized with unstable angina eventually receive a non–cardiac-related diagnosis, yet 5 percent of patients with myocardial infarction are inappropriately discharged from the emergency department. We evaluated the safety, efficacy, and cost of admission to a chest-pain observation unit (CPU) located in the emergency department for such patients. Methods We performed a community-based, prospective, randomized trial of the safety, efficacy, and cost of admission to a CPU as compared with those of regular hospital admission for patients with unstable angina who were considered to be at intermediate risk for cardiovascular events in the short term. A total of 424 eligible patients were randomly assigned to routine hospital admission (a monitored bed under the care of the cardiology service) or admission to the CPU (where patients were cared for according to a strict protocol including aspirin, heparin, continuous ST-segment monitoring, determination of creatine kinase is...read more
Citations
More filters
Journal ArticleDOI
Diagnostic uncertainty and costs associated with current emergency department evaluation of low risk chest pain.
TL;DR: The probability of going to the OU and having a positive or indeterminate stress test resulting in a subsequent negative catheterization was double the probability of having a stress test result in catheterizations that detected significant coronary artery disease.
Journal ArticleDOI
Coronary computed tomography and triple rule out CT in patients with acute chest pain and an intermediate cardiac risk for acute coronary syndrome: Part 2: Economic aspects
Thomas Henzler,Thomas Henzler,Joachim Gruettner,Mathias Meyer,Mathias Meyer,Baerbel Rothhaar,Paul Apfaltrer,Paul Apfaltrer,Franz Metzger,Martin Borggrefe,U. Joseph Schoepf,Stefan O. Schoenberg,Christian Fink +12 more
TL;DR: Integrating cCTA or TRO-CTA in a SOC algorithm can safely reduce the number of hospitalized patients and reduce total health care costs.
Journal ArticleDOI
Cardiac emergency triage and therapeutic decisions using whole blood rapid troponin T test for patients with suspicious acute coronary syndrome.
TL;DR: The positive predictive value of ECG diagnosis was inferior to the rapid troponin T test, which reflected the prudent attitude of physicians taking ECG decisions as positive when myocardial ischemia was suspected, and the diagnostic efficacy was remarkable in patients with the non-ST elevation type of acute coronary syndrome.
Journal ArticleDOI
ROMEO: a rapid rule out strategy for low risk chest pain. Does it work in a UK emergency department?
C Taylor,A Forrest-Hay,S Meek +2 more
TL;DR: A rapid rule out strategy such as the ROMEO pathway is feasible in the UK healthcare setting and provides standardised and consistent evaluation.
Journal ArticleDOI
Current management of non-ST-segment-elevation acute coronary syndrome: reconciling the results of randomized controlled trials.
TL;DR: Higher-risk patients should be admitted for pharmacologic stabilization and assessed by coronary angiography within 48h with the aim of early revascularization, provided the risk of periprocedural complications is not prohibitive, and stratification be conducted at presentation using clinical features, the electrocardiogram, and biomarkers.
References
More filters
Journal ArticleDOI
Prognostic Value of a Treadmill Exercise Score in Outpatients with Suspected Coronary Artery Disease
Daniel B. Mark,Linda Shaw,Frank E. Harrell,Mark A. Hlatky,Kerry L. Lee,James R. Bengtson,Charles B. McCants,Robert M. Califf,David B. Pryor +8 more
TL;DR: The treadmill score is a useful and valid tool that can help clinicians determine prognosis and decide whether to refer outpatients with suspected coronary disease for cardiac catheterization, and was a better predictor of outcome than the clinical assessment.
Journal ArticleDOI
Missed diagnoses of acute myocardial infarction in the emergency department: Results from a multicenter study
Bruce D. McCarthy,Joni R. Beshansky,Joni R. Beshansky,Ralph B. D'Agostino,Ralph B. D'Agostino,Harry P. Selker,Harry P. Selker +6 more
TL;DR: The rate of missed acute myocardial infarction in the emergency department was only 1.9%, but death or potentially lethal complications occurred in 25% of missed AMI patients, and another 25% might have been prevented had patients who were recognized to have ischemic heart disease by the physician in the ED been admitted.
Journal ArticleDOI
A Rapid Diagnostic and Treatment Center for Patients With Chest Pain in the Emergency Department
Gibler Wb,John Paul Runyon,Levy Rc,Michael R. Sayre,Kacich R,Charles R. Hattemer,Hamilton C,Gerlach Jw,Walsh Ra +8 more
TL;DR: The Heart ER program provides an effective method for evaluating low- to moderate-risk patients with possible acute ischemic coronary syndrome in the ED setting.
Journal ArticleDOI
Comprehensive Strategy for the Evaluation and Triage of the Chest Pain Patient
James L. Tatum,Robert L. Jesse,Michael C. Kontos,Christopher S. Nicholson,Kristin L Schmidt,Charlotte S. Roberts,Joseph P. Ornato +6 more
TL;DR: Rapid perfusion imaging plays a key role in the risk stratification of low-risk patients, allowing discrimination of unsuspected high risk patients who require prompt admission and possible intervention from those who are truly at low risk.
Related Papers (5)
Clinical characteristics and natural history of patients with acute myocardial infarction sent home from the emergency room.
ACC/AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: Executive summary and recommendations: A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee on the management of patients with unstable angina)
Eugene Braunwald,Elliott M. Antman,John W. Beasley,Robert M. Califf,Melvin D. Cheitlin,Judith S. Hochman,Robert H. Jones,Dean J. Kereiakes,Joel Kupersmith,Thomas N. Levin,Carl J. Pepine,John W. Schaeffer,Earl E. Smith,David E Steward,Pierre Theroux,Raymond J. Gibbons,Joseph S. Alpert,David P. Faxon,Valentin Fuster,Gabriel Gregoratos,Loren F. Hiratzka,Alice K. Jacobs,Sidney C. Smith +22 more