Many people in emergency department for chest pain don't need admitted

Their study, published in today's JAMA Internal Medicine, finds a very low short-term risk for life-threatening cardiac events among patients with chest pain who have normal cardiac blood tests, vital signs and electrocardiograms.

"We wanted to determine the risk to help assess whether this population of patients could safely go home and do further outpatient testing within a day or two," said Dr. Michael Weinstock, a professor of Emergency Medicine at The Ohio State University College of Medicine and chairman of the Emergency Department at Mt. Carmel St. Ann's Hospital.

The researchers looked at data from 45,416 emergency department visits for chest pain at three Columbus-area hospitals between July 2008 and June 2013. Of those, 11,230 met the criteria for the study. Weinstock and colleagues looked for a primary outcome of life-threatening arrhythmia, inpatient heart attack, cardiac or respiratory arrest, or death. One of these bad outcomes occurred in four of the patients. Using a random sample of the medical records, that translates to a life-threatening event in 0.06 percent of these patients, or one in every 1,817.

"This data shows routine hospital admission is not the best strategy for this group. We tend to admit a lot of people with chest pain out of concern for missing a heart attack or some other life-ending irregularity," Weinstock said. "To me, this says we can think more about what's best for the patient long term. I've been having these conversations with my patients, and only one wanted to stay in the hospital. Most people want to go home and get tests done the next day."

Additionally, Weinstock and his team believe current national guidelines to routinely admit, observe and test patients after a clean emergency department evaluation for chest pain should be reconsidered.

"We'd like to see more emergency medicine physicians having that bedside conversation to ensure the chest pain patient knows the risks and benefits of hospitalization compared to outpatient evaluation. We think continuing evaluation in an outpatient setting is not only safer for the patient, it's a less costly approach for the health care system," Weinstock said.

Additional team members included Dr. Colin Kaide from The Ohio State University Wexner Medical Center, Dr. Frank Orth, Dr. Douglas VanFossen and Judy Anderson from Mt. Carmel St. Ann's, Dr. Scott Weingart from Stony Brook Medicine and Dr. David Newman from Icahn School of Medicine.