Sharp, A.L., Kawatkar, A.A., Baecker, A.S. et al. (10 more authors) (2022) Does hospital admission/observation for chest pain improve patient outcomes after emergency department evaluation for suspected acute coronary syndrome? Journal of General Internal Medicine, 37 (4). pp. 745-752. ISSN 0884-8734
Abstract
Background
Chest pain is the top reason for hospitalization/observation in the USA, but it is unclear if this strategy improves patient outcomes.
Objective
The objective of this study was to compare 30-day outcomes for patients admitted versus discharged after a negative emergency department (ED) evaluation for suspected acute coronary syndrome.
Design
A retrospective, multi-site, cohort study of adult encounters with chest pain presenting to one of 13 Kaiser Permanente Southern California EDs between January 1, 2015, and December 1, 2017. Instrumental variable analysis was used to mitigate potential confounding by unobserved factors.
Patients
All adult patients presenting to an ED with chest pain, in whom an acute myocardial infarction was not diagnosed in the ED, were included.
Main Measures
The primary outcome was 30-day acute myocardial infarction or all-cause mortality, and secondary outcomes included 30-day revascularization and major adverse cardiac events.
Key Results
In total, 77,652 patient encounters were included in the study (n=11,026 admitted, 14.2%). Three hundred twenty-two (0.4%) had an acute myocardial infarction (n=193, 0.2%) or death (n=137, 0.2%) within 30 days of ED visit (1.5% hospitalized versus 0.2% discharged). Very few (0.3%) patients underwent coronary revascularization within 30 days (0.7% hospitalized versus 0.2% discharged). Instrumental variable analysis found no adjusted differences in 30-day patient outcomes between the hospitalized cohort and those discharged (risk reduction 0.002, 95% CI −0.002 to 0.007). Similarly, there were no differences in coronary revascularization (risk reduction 0.003, 95% CI −0.002 to 0.007).
Conclusion
Among ED patients with chest pain not diagnosed with an acute myocardial infarction, risk of major adverse cardiac events is quite low, and there does not appear to be any benefit in 30-day outcomes for those admitted or observed in the hospital compared to those discharged with outpatient follow-up.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2021, Society of General Internal Medicine. This is an author-produced version of a paper subsequently published in Journal of General Internal Medicine. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | cardiology; emergency medicine; health services research; hospital medicine; instrumental variable analysis |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research The University of Sheffield > Sheffield Teaching Hospitals |
Funding Information: | Funder Grant number NATIONAL HEART, LUNG, AND BLOOD INSTITUTE nan |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 19 May 2021 16:50 |
Last Modified: | 26 May 2022 14:05 |
Status: | Published |
Publisher: | Springer Nature |
Refereed: | Yes |
Identification Number: | 10.1007/s11606-021-06841-2 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:174374 |