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
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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
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Journal ArticleDOI
Continuous 12-lead electrocardiographic monitoring in an emergency department chest pain unit: an assessment of potential clinical effect.
Wyatt W. Decker,Laurence D. Prina,Peter A. Smars,Andrew J. Boggust,Alan R. Zinsmeister,Stephen L. Kopecky +5 more
TL;DR: Serial ECG is of limited value in the diagnostic evaluation of intermediate-risk patients managed in the chest pain unit with a standard protocol, however, when ST-segment changes are present, they indicate an increased likelihood for an adverse cardiac event.
Journal ArticleDOI
Assessment of myocardial ischemia with cardiovascular magnetic resonance.
TL;DR: This review will cover techniques of ischemia assessment with CMR by both stress-induced wall motion abnormalities as well as myocardial perfusion imaging, and the use of CMR for ischemIA assessment will be compared with other commonly used noninvasive modalities.
Journal ArticleDOI
Utility of the emergency department observation unit in ensuring stress testing in low-risk chest pain patients.
Troy Madsen,Michael Mallin,Joseph Bledsoe,Philip Bossart,Virgil Davis,Christopher Gee,Erik D. Barton +6 more
TL;DR: Among chest pain patients admitted to an ED observation unit, the rate of positive stress tests was 11%, and physicians would miss approximately 3.3% of patients with a positive stress test if these patients were discharged directly from the ED.
Journal ArticleDOI
Rationality and methods of ACCEPT registry - Brazilian registry of clinical practice in acute coronary syndromes of the Brazilian Society of Cardiology.
TL;DR: The analysis of this multicenter registry of patients diagnosed with acute coronary syndrome will design a horizontal perspective for the treatment of patients suffering from cardiovascular disease in Brazil.
Journal ArticleDOI
Acute chest pain--identification of patients at low risk for coronary events. The impact of symptoms, medical history and risk factors.
Martin Schillinger,Gottfried Sodeck,Giora Meron,Karin Janata,Mariam Nikfardjam,F. Rauscha,Anton N. Laggner,Hans Domanovits +7 more
TL;DR: The predictive value of characteristics atypical for myocardial ischemia for exclusion of acute or subacute coronary events remains challenging, as it implies the risk of fatal misdiagnosis.
References
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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.
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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.
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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