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Chest Pain Units in Deutschland

Eine kritische Bestandsaufnahme

Chest pain units in Germany

Critical assessment

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Zusammenfassung

Hintergrund

Die Sterblichkeit an koronarer Herzkrankheit nimmt seit Jahrzehnten ab, was v. a. auf Fortschritte in deren Primär- und Sekundärprävention zurückzuführen ist. Aber auch die in den 1980er Jahren von US-amerikanischen Notfallmedizinern, Kardiologen und spezialisiertem Krankenpflegepersonal initiierte Koordination und Standardisierung der Evaluation und Akuttherapie von Patienten mit Verdacht auf ein akutes Koronarsyndrom verbesserten die Qualität der medizinischen Versorgung. Neben der Abstimmung medizinisch-fachlicher Ziele und Inhalte wurden interdisziplinär entwickelte evidenzbasierte Vorgehensweisen implementiert. Hierdurch konnten – ohne die Sicherheit der Patienten zu gefährden – sowohl der Anteil der stationär zu versorgenden Patienten als auch die Kosten reduziert werden.

Entstehungsgeschichte der Chest Pain Units

Die Deutsche Gesellschaft für Kardiologie schlägt für Deutschland einheitliche Standards für die Struktur und Organisation der Evaluation von Patienten mit unklarem Brustschmerz vor und regte die Zertifizierung von Chest Pain Units an. Deren Entstehungsgeschichte in Deutschland und aktuelle internationale Entwicklungen im Zusammenhang mit dem derzeitigen Entwicklungsstand der klinischen Notfall- und Akutmedizin in Deutschland werden betrachtet und kritisch bewertet.

Abstract

Background

Mortality of coronary artery disease has continued to significantly decrease in recent decades. This is due to the advancements of primary and secondary prevention for coronary artery disease. In addition, coordination and standardization of the recognition, diagnosis, and acute treatment of patients with acute coronary syndrome (ACS) has significantly contributed to the improved management of affected patients. Since the 1980s, emergency physicians, cardiologists, and advanced nurse practitioners have developed evidence-based treatment protocols, which have contributed to reducing the proportion of patients needing hospitalization. This was associated with significant reductions in cost without reducing treatment quality.

Development of chest pain units

The German Society of Cardiology recommends standardized procedures for the structure and evaluation of patients with acute chest pain including a dedicated certification campaign. In this manuscript, we review the development of chest pain units in Germany and critically discuss this initiative with international models of chest pain center evaluation in emergency departments.

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Abbreviations

ACB:

Aortokoronarer Bypass

ACS:

Akutes Koronarsyndrom

AMI:

Akuter Myokardinfarkt

A.p.:

Angina pectoris

aVR:

„Augmented voltage right“

CCU:

„Coronary care unit“

CPU:

Chest Pain Unit

cTn:

Kardiales Troponin

DGK:

Deutsche Gesellschaft für Kardiologie

EHAC:

Early heart attack care

EKG:

Elektrokardiogramm

ESCAPE :

„Effectiveness and safety of chest pain assessment to prevent emergency admissions“

GRACE:

„Global registry of acute coronary events“

KHK:

Koronare Herzerkrankung

MI:

Myokardinfarkt

MONICA:

„Monitoring trends and determinants in cardiovascular disease“

NSTE:

Non-ST-elevation

PCI:

Perkutane Koronarintervention

ST:

ST-Strecke

STEMI:

ST-Elevations-Myokardinfarkt

T:

T-Welle

TIMI:

„Thrombolysis in myocardial infarction“

WHO:

World Health Organization

ZNA:

Zentrale Notaufnahme

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Authors and Affiliations

  1. Klinik für Notfall- und Internistische Intensivmedizin, Klinikum Nürnberg, Prof.-Ernst-Nathan-Straße 1, 90419, Nürnberg, Deutschland

    M. Christ, J. Schmidt & S. Popp

  2. Masterstudiengang MSc Medical Process Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland

    H. Mang

Authors
  1. M. Christ
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  2. J. Schmidt
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  3. S. Popp
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  4. H. Mang
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Correspondence to M. Christ.

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Christ, M., Schmidt, J., Popp, S. et al. Chest Pain Units in Deutschland. Notfall Rettungsmed 15, 383–391 (2012). https://doi.org/10.1007/s10049-012-1596-3

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