Skip to main content
SpringerLink
Log in

Reduktion der stationären Verweildauer bei Patienten mit akutem Koronarsyndrom durch Einrichtung einer Chest Pain Unit

The length of hospital stay in patients with acute coronary syndrome is reduced by establishing a chest pain unit

  • Originalarbeit
  • Published:
Herz Aims and scope Submit manuscript

Zusammenfassung

Zielsetzung

In der Versorgung eines akuten Koronarsyndroms (ACS) stellen einerseits die rasche und adäquate Behandlung und andererseits gestiegene ökonomische Bedürfnisse große Anforderungen an eine Notaufnahme (NA). Ziel dieser Untersuchung ist es, den Einfluss einer Chest Pain Unit (CPU) auf die stationäre Verweildauer von Patienten mit ACS aufzuzeigen.

Methode

Patienten, die sich zwischen 05/04 und 05/06 mit Verdacht auf ACS in einer internistischen NA sowie in einer CPU vorstellten, wurden in dieser retrospektiven Analyse untersucht. Die untersuchte CPU nahm ihre Arbeit im Juli 2005 auf. Es erfolgte eine standardisierte retrospektive Datenerhebung anhand aller verfügbaren klinischen Unterlagen.

Ergebnisse

Es wurden 247 Patienten der NA und 765 der CPU untersucht. In der NA wurde die Diagnose Myokardinfarkt mit ST-Strecken-Hebung (STEMI) bei 29 (11,7%), Myokardinfarkt ohne ST-Strecken-Hebung (NSTEMI) bei 38 (15,4%) und instabile Angina pectoris (IAP) bei 15 (6,1%) Patienten gestellt. Bei 165 (66,8%) Patienten konnte ein ACS ausgeschlossen werden. In der CPU lagen die Inzidenz eines ACS mit 75 (9,8%) STEMI, 128 (16,7%) NSTEMI und 136 (17,8%) IAP höher; ein ACS konnte hier bei 426 (55,7%) Patienten ausgeschlossen werden. Es zeigte sich eine Reduktion der medianen Verweildauer für ACS-Patienten von 8,0 Kliniktagen bei Aufnahme in der NA auf 5,0 Tage bei Aufnahme in der CPU (p<0,001). Bei Patienten mit IAP bestand kein Unterschied; bei Patienten mit STEMI konnte eine Reduktion von 8,0 auf 7,0 Tage (p=0,042), mit NSTEMI eine Reduktion von 8,0 auf 6,0 Tage (p=0,002) beobachtet werden.

Schlussfolgerung

Durch Optimierung innerklinischer Abläufe im Rahmen der Etablierung einer CPU konnte bei leitliniengerechter Behandlung des ACS eine deutliche Reduktion der stationären Verweildauer beobachtet werden.

Abstract

Background

Providing prompt and appropriate therapy, combined with the increased economic requirements of treating patients with acute coronary syndrome (ACS), places high demands on the emergency department. The aim of the present analysis is to evaluate to what extent establishing a dedicated chest pain unit (CPU) influences the length of hospital stay in ACS patients.

Methods

Patients presenting with suspected ACS between 05/2004 and 05/2006 to either the emergency department (ED) or the newly established CPU were retrospectively analyzed. The CPU became functional in July 2005. Data were obtained according to standardized procedures based on patient charts and all available clinical information.

Results

A total of 247 patients were treated in the ED and 765 in the CPU. In the ED patient group 29 (11.7%) were diagnosed with ST elevation myocardial infarction (STEMI), 38 (15.4%) with non-ST elevation myocardial infarction (NSTEMI) and 15 (6.1%) with unstable angina pectoris (UAP), while ACS could be excluded in 165 (66.8%) patients. Patients treated in the CPU showed a higher percentage of ACS with 75 (9.8%) STEMI, 128 (16.7%) NSTEMI and 136 (17.8%) UAP patients; ACS could be excluded in 426 (55.7%) patients.

The median length of hospital stay was shorter in ACS patients treated in the CPU at 5.0 days compared to 8.0 days if admitted to the ED (p<0.001). No difference in length of hospital stay was observed in UAP patients, whereas in STEMI patients admitted to the ED the time was longer at 8.0 days compared to 7.0 days if admitted to the CPU (p=0.042). A reduction from 8.0 to 6.0 days in the length of hospital stay if admitted to the CPU compared to the ED could be observed (p=0.002) in NSTEMI patients.

Conclusions

Establishing a chest pain unit with optimized diagnostic and structural processes is associated with reduced lengths of hospital stay in patients with ACS treated according to current guidelines and recommendations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Nawar E, Niska R, Xu J (2007) National hospital ambulatory medical care survey: 2005 emergency department summary. Adv Data:1–32

    Google Scholar 

  2. Pope J, Aufderheide T, Ruthazer R et al (2000) Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med 342:1163–1170

    Article  PubMed  CAS  Google Scholar 

  3. Keller T, Zeller T, Peetz D et al (2009) Sensitive troponin I assay in early diagnosis of acute myocardial infarction. N Engl J Med 361:868–877

    Article  PubMed  CAS  Google Scholar 

  4. Björk J, Forberg J, Ohlsson M et al (2006) A simple statistical model for prediction of acute coronary syndrome in chest pain patients in the emergency department. BMC Med Inform Decis Mak 6:28

    Article  PubMed  Google Scholar 

  5. Kastrati A, Mehilli J, Neumann F et al (2006) Abciximab in patients with acute coronary syndromes undergoing percutaneous coronary intervention after clopidogrel pretreatment: the ISAR-REACT 2 randomized trial. JAMA 295:1531–1538

    Article  PubMed  CAS  Google Scholar 

  6. Mehta S, Granger C, Boden W et al (2009) Early versus delayed invasive intervention in acute coronary syndromes. N Engl J Med 360:2165–2175

    Article  PubMed  CAS  Google Scholar 

  7. Allen L, O’Donnell C, Giugliano R et al (2004) Care concordant with guidelines predicts decreased long-term mortality in patients with unstable angina pectoris and non-ST-elevation myocardial infarction. Am J Cardiol 93:1218–1222

    Article  PubMed  Google Scholar 

  8. Gibler W, Runyon J, Levy R et al (1995) A rapid diagnostic and treatment center for patients with chest pain in the emergency department. Ann Emerg Med 25:1–8

    Article  PubMed  CAS  Google Scholar 

  9. Genth-Zotz S, Post F, Keller T et al (2007) Chest Pain Unit (CPU): erste Erfahrungen in Mainz. Kardiologie up2date 3:197–200

    Article  Google Scholar 

  10. Keller T, Post F, Tzikas S et al (2010) Improved outcome in acute coronary syndrome by establishing a chest pain unit. Clin Res Cardiol 99:149–155

    Article  PubMed  Google Scholar 

  11. Tzikas S, Keller T, Post F et al (2010) Patient satisfaction in acute coronary syndrome. Improvement through the establishment of a chest pain unit. Herz 35:403–409 [Article in German]

    Article  PubMed  CAS  Google Scholar 

  12. Breuckmann F, Post F, Giannitsis E et al (2008) Kriterien der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung für „Chest-Pain-Units“. Kardiologe 2:389–394

    Article  Google Scholar 

  13. Gomez M, Anderson J, Karagounis L et al (1996) An emergency department-based protocol for rapidly ruling out myocardial ischemia reduces hospital time and expense: results of a randomized study (ROMIO). J Am Coll Cardiol 28:25–33

    Article  PubMed  CAS  Google Scholar 

  14. Goodacre S, Nicholl J, Dixon S et al (2004) Randomised controlled trial and economic evaluation of a chest pain observation unit compared with routine care. BMJ 328:254

    Article  PubMed  Google Scholar 

  15. Thygesen K, Alpert J, White H et al (2007) Universal definition of myocardial infarction. Circulation 116:2634–2653

    Article  PubMed  Google Scholar 

  16. Fox K, Dabbous O, Goldberg R et al (2006) Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ 333:1091

    Article  PubMed  Google Scholar 

  17. Terkelsen C, Lassen J, Nørgaard B et al (2005) Mortality rates in patients with ST-elevation vs. non-ST-elevation acute myocardial infarction: observations from an unselected cohort. Eur Heart J 26:18–26

    Article  PubMed  Google Scholar 

  18. Hoenig M, Doust J, Aroney C, Scott I (2006) Early invasive versus conservative strategies for unstable angina & non-ST-elevation myocardial infarction in the stent era. Cochrane Database Syst Rev 3:CD004815

    PubMed  Google Scholar 

  19. Rogers W, Canto J, Lambrew C et al (2000) Temporal trends in the treatment of over 1.5 million patients with myocardial infarction in the us from 1990 through 1999: the National Registry of Myocardial Infarction 1, 2 and 3. J Am Coll Cardiol 36:2056–2063

    Article  PubMed  CAS  Google Scholar 

  20. Budaj A, Brieger D, Steg P et al (2003) Global patterns of use of antithrombotic and antiplatelet therapies in patients with acute coronary syndromes: insights from the Global Registry of Acute Coronary Events (GRACE). Am Heart J 146:999–1006

    Article  PubMed  Google Scholar 

  21. Diagnosedaten der Krankenhäuser ab 2000 (2008) http://www.gbe-bund.de

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Author notes

  1. T. Keller

    Present address: Universitäres Herzzentrum Hamburg, Allgemeine und Interventionelle Kardiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

Authors and Affiliations

  1. II. Medizinische Klinik und Poliklinik für Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsmedizin der Johannes-Gutenberg-Universität, Mainz, Mainz, Deutschland

    T. Keller, S. Tzikas, O. Scheiba, F. Post, S. Arnolds, S. Blankenberg, A. Warnholtz, T. Münzel & S. Genth-Zotz

  2. Universitäres Herzzentrum Hamburg, Allgemeine und Interventionelle Kardiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    S. Blankenberg

  3. Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), Universitätsmedizin der Johannes-Gutenberg-Universität, Mainz, Deutschland

    U. Krahn

Authors
  1. T. Keller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Tzikas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. O. Scheiba
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. U. Krahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F. Post
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. Arnolds
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. Blankenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Warnholtz
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. T. Münzel
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. S. Genth-Zotz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Keller.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Keller, T., Tzikas, S., Scheiba, O. et al. Reduktion der stationären Verweildauer bei Patienten mit akutem Koronarsyndrom durch Einrichtung einer Chest Pain Unit. Herz 37, 301–307 (2012). https://doi.org/10.1007/s00059-011-3544-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00059-011-3544-2

Schlüsselwörter

Keywords

Search

Navigation