Abstract 17664: Outcomes of Chest Pain Calls to an Advice and Appointment Call Center
Telephone triage of chest pain (CP) can provide appropriate emergent referral in an Advice and Appointment Call Center (AACC) using electronic medical records (EMR) and advice nurses (RN) consulting Emergency Department (ED) physicians. CP is the cardinal symptom in patients who present with acute coronary syndrome. Many patients are uncertain about the significance of the CP and call an advice line instead of going directly to an emergency room. Optimizing triage of patients who call the AACC with CP by identifying their risk profile is especially important in patients without a known history of coronary artery disease (CAD).
Methods and Results: This is a population-based, retrospective cohort study of patients calling the Kaiser Permanente Northern California AACC about CP of possible cardiac origin. The study included 54,925 calls for CP from patients age 40 years and older with no documented history of CAD in the 18 months prior to the initial call. A multivariate risk analysis was performed for all CP calls to assess the correlation of cardiac risk factors with the subsequent diagnosis of CAD. Increasing age was the best predictor of a diagnosis of CAD within 30 days with an odds ratio (OR) of 2.18 (CI = 1.92 - 2.48) for those aged 50-<60, versus those aged 40 - <50, and with the odds ratio increasing by decade of age to 5.59 (CI = 4.73 - 6.60) for those aged 80 and older. Male gender was the next highest predictor with an OR of 2.63 (CI = 2.43 - 2.84). Clinical risk factors that were weaker predictors included diabetes with an OR of 1.35 (CI = 1.22 -1.50) and hyperlipidemia with OR of 1.31 (CI = 1.19 - 1.45). ACE inhibitor use was not protective with an OR of 1.06 (CI = 0.96 - 1.17). We reviewed the outcomes for the 16,223 ED visits by patients who called the AACC for CP and were directed to the ED. Of these, 23.3% resulted in hospitalization with a 2.1% rate of myocardial infarction and 30-day all cause mortality of 0.4%.
Conclusions: Telephone triage and advice by RNs in consultation with ED physicians using EMR has been used effectively to manage patients with CP who called an AACC. Increasing age and male gender were the strongest predictors for CAD while other factors including diabetes and hyperlipidemia were significant but weaker predictors.
- © 2012 by American Heart Association, Inc.