Abstract 14237: Inpatient Stress Testing Reduces Subsequent ED visits and Readmissions for Chest Pain
Introduction: For patients admitted for observation of chest pain, stress tests increase length of hospitalization and cost. It is not known whether stress testing prevents recurrent emergency department (ED) visits or readmissions for chest pain.
Hypothesis: We hypothesized that inpatient stress testing would reduce subsequent ED visits and readmissions for chest pain.
Methods: We performed a retrospective cohort study using a hospital administrative database. All patients aged >=18 years who were admitted under “observation status” to Baystate Medical Center between January 2007 and July 2009 with admission diagnosis of Chest Pain or Angina Pectoris without acute coronary syndromes (ACS) and no admissions for 12 months prior were included. We compared subsequent ED visits and readmissions within one year among patients who had a stress test at index admission vs. those who did not, using multivariate logistic regression to adjust for age, gender, insurance status and comorbidities.
Results: A total of 2933 chest pain patients were admitted during the study period; 2120 (72.3%) had a stress test during the index admission. Within 1 year, 314 (10.7%) patients returned to the ED with chest pain, and 148 (47%) of these were readmitted. Patients who had a stress test at index admission were less likely than those who did not have a stress test to return to the ED (9.2% vs. 14.4%; p<0.001). In the multivariable model, a return ED visit was positively associated with Hispanic ethnicity (OR 1.6, 95% CI 1.1, 2.4), ≥1 cardiac comorbidity (OR 7.3, 95% CI 4.4, 12) and public insurance (OR 1.8, 95% CI 1.4, 2.4) and was negatively associated with stress testing (OR 0.7, 95% CI 0.5, 0.9). Once in the ED, however, the odds of admission was similar between those who previously had a stress test and those who did not (adjusted OR 0.9, 95% CI: 0.5, 1.5).
Conclusion: Among patients admitted for observation for chest pain after ACS is ruled out, inpatient stress testing is associated with reduced readmission, primarily by preventing ED visits for chest pain. Upon return to the ED, stress testing is not associated with the decision to admit.
- © 2011 by American Heart Association, Inc.