Abstract 16257: Chest Pain Clinic Assessment After Emergency Department Discharge With Low Risk Chest Pain is Associated With a Reduction in Hospitalizations and Emergency Re-Visitation
Background: Chest pain (CP) is a leading cause of emergency department (ED) visitation. The optimal outpatient assessment of low risk troponin negative CP patients discharged from the ED remains unclear.
Methods: Using a population based provincial sample of 28,987 patients discharged home from an ED following a CP presentation with a negative troponin measurement between April 2012 and March 2013 in Alberta Canada, we stratified patients into three follow-up care cohorts: (1) Chest Pain Clinics (CPC; n=2 804), (2) specialist follow-up (SFU; n=4 046) with an Internist or Cardiologist without formalized coronary risk stratification testing, or (3) no specialist follow-up (NFU; n=22 137). Outcomes of interest included 30 and 90 day incidence of ED re-visit, hospitalization, or death.
Results: The overall incidence of ED re-visit, hospitalization, and death at 30 and 90 days was , 1.06, 2.26, 0.05% and 9.64, 4.55, 0.1% respectively. The unadjusted 30 and 90-day incidences of ED re-visit and hospitalization were lowest in patients who attended a CPC (Table 1). After multivariable adjustment using CPC as reference the 30 and 90 day ED re-visit and hospitalization rates were significantly higher among patients with SFU or NFU after ED discharge. No differences in mortality were observed.
Conclusion: Dedicated chest pain assessment clinics for the follow-up of low risk CP patients discharged from the ED is associated with reduced ED re-visitation and hospitalization rates.
Table: ED post-discharge outcome for low risk chest pain stratified by follow-up.
*RAR: risk-adjusted rates in percentage (%)
** Due to very small number of deaths within 30 days, the risk-adjusted results for death were not provided.
Author Disclosures: A.G. Howarth: Honoraria; Modest; Amgen. Y. Ji: None. B. Mann: None. A. Ryan: None. J. Stone: None. A. Nanji: None. S. van Diepen: None.
- © 2016 by American Heart Association, Inc.