People who come to the emergency department for chest pain but who have normal cardiac blood tests, vital signs and electrocardiograms are at low short-term risk for life-threatening cardiac events and may not need to be admitted to the hospital, according to a study published in JAMA Internal Medicine.
Researchers examined data from 11,230 emergency department visits for chest pain at three hospitals in the Columbus, Ohio, area between July 2008 and June 2013 that met criteria for the study. They looked for a primary outcome of life-threatening arrhythmia, inpatient heart attack, cardiac or respiratory arrest, or death. One of those outcomes occurred in four of the patients, which translates to a life-threatening event in 0.06 percent of these patients, or one in every 1,817.
Emergency department physicians tend to admit a lot of chest pain patients to the hospital for fear of missing a heart attack or another possibly deadly problem, according to Michael Weinstock, MD, a professor of emergency medicine at The Ohio State University College of Medicine and chairman of the ED at Mt. Carmel St. Ann's Hospital.
"The data shows routine hospital admission is not the best strategy for this group," he said. After the study, Dr. Weinstock and his team believe that national guidelines pushing physicians to routinely admit, observe and test patients after a routine ED evaluation should be reconsidered.
"We think continuing evaluation in an outpatient setting is not only safer for the patient, it's a less costly approach for the healthcare system," Dr. Weinstock said.