Received care compared to ADP-guided care of patients admitted to hospital with chest pain of possible cardiac origin

Michael Perera,1 Leena Aggarwal,1 Ian A Scott,2,3 Bentley Logan1 1Medical Assessment and Planning Unit, Princess Alexandra Hospital, Brisbane, QLS, Australia; 2Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, QLS, Australia; 3School of Clinical Medicine, University of Queensland, Brisbane, QLS, Australia Purpose: To assess the extent to which accelerated diagnostic protocols (ADPs), compared to traditional care, identify patients presenting to emergency departments (EDs) with chest pain who are at low cardiac risk and eligible for early ED discharge. Patients and methods: Retrospective study of 290 patients admitted to hospital for further evaluation of chest pain following negative ED workup (no acute ischemic electrocardiogram [ECG] changes or elevation of initial serum troponin assay). Demographic data, serial ECG and troponin results, Thrombolysis in Myocardial Infarction (TIMI) score, cardiac investigations, and outcomes (confirmed acute coronary syndrome [ACS] at discharge and major adverse cardiac events [MACEs]) over 6 months of follow-up were analyzed. A validated ADP (ADAPT-ADP) was retrospectively applied to the cohort, and processes and outcomes of ADP-guided care were compared with those of care actually received. Results: Patients had mean (±SD) TIMI score of 1.8 (±1.7); six (2.0%) patients were diagnosed with ACS at discharge. At 6 months, one patient (0.3%) re-presented with ACS and two (0.6%) died of non-coronary causes. The ADAPT-ADP defined 97 (33.4%) patients as being at low risk and eligible for early ED discharge, but who instead incurred mean hospital stay of 1.5 days, with 40.2% in telemetry beds, and 21.6% subject to non-invasive testing with only one positive result for coronary artery disease. None had a discharge diagnosis of ACS or developed MACE at 6 months. Conclusion: Compared to traditional care, application of the ADAPT-ADP would have allowed one-third of chest pain patients with initially negative investigations in ED to have been safely discharged from ED. Keywords: chest pain, accelerated diagnostic protocol, investigation, coronary outcome