Journal of Nuclear Cardiology

, Volume 15, Issue 2, pp 186–192

Differences in diagnostic evaluation and clinical outcomes in the care of patients with chest pain based on admitting service: The benefits of a dedicated chest pain unit

  • Nir N. Somekh
  • Maurice Rachko
  • Gregg Husk
  • Patricia Friedmann
  • Steven R. Bergmann
Original Articles
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Abstract

Background

Chest pain is one of the most common complaints of patients presenting at emergency departments. However, the most appropriate diagnostic evaluation for patients with chest pain but without acute coronary syndrome remains controversial, and differs greatly among institutions and physicians. At our institution, patients with chest pain can be admitted to an internist-run hospitalist service, a private attending service, or a cardiologist-run Chest Pain Unit. The goal of the present study was to compare the management and outcomes of patients admitted with chest pain based on admitting service.

Methods

The charts of 750 patients (250 consecutive patients per service) with a discharge diagnosis of chest pain were studied retrospectively.

Results

Patients admitted to the Chest Pain Unit were younger and had a lower prevalence of known coronary artery disease, hypertension, or diabetes, but a similar prevalence of other risk factors compared with the other groups. Sixty percent of the patients in the Chest Pain Unit underwent stress myocardial perfusion imaging as their primary diagnostic modality (vs 22% and 12% of patients in the hospitalist and private services, respectively; P<.001). In contrast, 35% of the patients admitted to the hospitalist service underwent rest echocardiography (vs 8% and 17% of patients in the Chest Pain Unit and private services, respectively; P<.001). Finally, 47% of the patients in the private service underwent coronary angiography as their primary diagnostic modality (vs 6% and 10% of patients in the Chest Pain Unit and hospitalist services, respectively; P<.001). The length of stay was shortest for patients in the Chest Pain Unit (1.4±1.2 days vs 3.9±3.4 days and 3.5±3.6 days in the hospitalist and private services, respectively; P<.001), even when corrected for patient age and number of risk factors. Readmission within 6 months was lowest for patients in the Chest Pain Unit (4.4% vs 17.6% and 15.2% in the hospitalist and private services, respectively; P<.001).

Conclusions

The results of this study demonstrate that a highly protocolized chest pain unit, using myocardial perfusion imaging as primary diagnostic modality, results in a decreased length of stay and readmission rate.

Key Words

Chest pain unit coronary artery disease myocardial perfusion imaging chest pain 

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Copyright information

© American Society of Nuclear Cardiology 2008

Authors and Affiliations

  • Nir N. Somekh
    • 4
  • Maurice Rachko
    • 1
  • Gregg Husk
    • 2
  • Patricia Friedmann
    • 3
  • Steven R. Bergmann
    • 1
  1. 1.Division of CardiologyBeth Israel Medical CenterNew York
  2. 2.Department of Emergency MedicineBeth Israel Medical CenterNew York
  3. 3.Office of Grants and Research AdministrationBeth Israel Medical CenterNew York
  4. 4.Department of Internal MedicineBeth Israel Medical CenterNew York

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