“Chest pain—please admit”: is there an alternative?: A rapid cardiological assessment service may prevent unnecessary admissions
Reads0
Chats0
TLDR
Any scheme which safely avoided these unnecessary admissions might save resources, reduce stress for patients, and, crucially, reduce the worrying false negatives—those missed cases of high risk coronary heart disease.Abstract:
Emergency medical admissions are important. They continue to rise year after year; consume substantial NHS resources; disrupt other NHS activities; and generate winter bed crises.1 2 Patients with acute central chest pain account for 20-30% of emergency medical admissions.3 4 Most are admitted because of concern about unstable coronary heart disease. Yet fewer than half will have a final diagnosis of acute myocardial infarction or unstable angina.4 Patients without high risk coronary heart disease thus account for over half those presenting with chest pain and over 10% of all emergency medical admissions. Such patients could be safely managed without admission, and most would prefer it. The current system is therefore both ineffective and inefficient. Any scheme which safely avoided these unnecessary admissions might save resources, reduce stress for patients, and, crucially, reduce the worrying false negatives—those missed cases of high risk coronary heart disease. …read more
Citations
More filters
Journal ArticleDOI
The telecardiology revolution: improving the management of cardiac disease in primary care.
TL;DR: Telecardiology allows for the remote specialist interpretation of electrocardiographic recordings via telephone transmission and is set to revolutionize cardiac care in the community, making savings and bridging the gap between primary and secondary care.
Journal ArticleDOI
Chest pain in the emergency department: the broad spectrum of causes.
TL;DR: The broad spectrum of causes of chest pain in patients presenting to the emergency department and to compare the diagnoses in referred patients, self-referred patients and patients rushed in by ambulance was described.
Journal ArticleDOI
Short-term and long-term outcomes in 133 429 emergency patients admitted with angina or myocardial infarction in Scotland, 1990–2000: population-based cohort study
Simon Capewell,Niamh F. Murphy,Kate MacIntyre,Susan Frame,Simon Stewart,J Chalmers,James Boyd,Alan Finlayson,Adam Redpath,John J.V. McMurray +9 more
TL;DR: Longer-term case fatality was similarly high in patients with angina and in survivors of AMI, about 5% a year, which may strengthen the case for aggressive secondary prevention in all patients presenting with acute coronary syndrome.
Journal ArticleDOI
Chest pain units.
TL;DR: Patients presenting to hospital with chest pain represent a substantial burden to the NHS and most clinicians working in emergency departments rely on the history, clinical examination, and electrocardiogram (ECG) to decide which patients have acute coronary syndromes and need admission and which to send home.
Journal ArticleDOI
Considerations for early acute myocardial infarction rule-out for emergency department chest pain patients: the case of copeptin.
Giuseppe Lippi,Mario Plebani,Salvatore Di Somma,Valter Monzani,Marco Tubaro,Massimo Volpe,Paolo Moscatelli,Arialdo Vernocchi,Mario Cavazza,Marcello Galvani,Piero Cappelletti,Giancarlo Marenzi,Simona Ferraro,Alberto Lombardi,Andrea Peracino +14 more
TL;DR: Current evidence about the clinical significance of copeptin testing in the ED as well as its appropriate placing within diagnostic protocols are reviewed.
References
More filters
Journal ArticleDOI
1999 update: ACC/AHA guidelines for the management of patients with acute myocardial infarction: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction)
Thomas J. Ryan,Elliott M. Antman,Neil H. Brooks,Robert M. Califf,L. David Hillis,Loren F. Hiratzka,Elliot Rapaport,Barbara Riegel,R. O. Russell,Earl E. Smith,W. Douglas Weaver,Raymond J. Gibbons,Joseph S. Alpert,Kim A. Eagle,Timothy J. Gardner,Arthur Garson,Gabriel Gregoratos,Sidney C. Smith +17 more
TL;DR: These guidelines are intended for physicians, nurses, and allied healthcare personnel who care for patients with suspected or established acute myocardial infarction and promote rapid identification and treatment of patients with acute MI.
Journal ArticleDOI
ACC/AHA Guidelines for the Management of Patients With Acute Myocardial Infarction
Thomas J. Ryan,Jeffrey L. Anderson,Elliott M. Antman,Blaine A. Braniff,Neil H. Brooks,Robert M. Califf,L. David Hillis,Loren F. Hiratzka,Elliott Rapaport,Barbara Riegel,R. O. Russell,Earl E. Smith,W. Douglas Weaver,James L. Ritchie,Melvin D. Cheitlin,Kim A. Eagle,Timothy J. Gardner,Arthur Garson,Raymond J. Gibbons,Richard P. Lewis,Robert A. O'Rourke +20 more
TL;DR: The American College of Cardiology and the American Heart Association request that the following format be used when citing this document: Ryan TJ, Antman EM, Brooks NH, Califf RM, Hillis LD, Hiratzka LF, Rapaport E, Riegel B, Russell RO, Smith EE III, Weaver WD.
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
TL;DR: 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.
A clinical trial of a chest-pain observation unit for patients with unstable angina
E. F Arkouh,P Eter A. S Mars,G Uy S. R Eeder,A Lan,R. Z Insmeister,R Oger W. E Vans,T Homas D. M Eloy,L. K Opecky,M Arvin A Llen,T Homas G. A Llison,R Aymond J. G Ibbons,E. G Abriel +11 more
Journal ArticleDOI
The continuing rise in emergency admissions
TL;DR: Analysis of linked data has confirmed that the rise in emergency admissions in Scotland is genuine, and only 2% of the increase can be explained by population aging.