Chest Pain Clinic Reduces Emergency Department and Hospital ‘Frequent Fliers’

NEW ORLEANS, LA—Low-risk patients with chest pain who follow-up with a dedicated chest pain clinic are less likely to return to the hospital and emergency room, according to the results of a new study.

Among nearly 29,000 patients discharged from the emergency department (ED) following a presentation with chest pain but a negative troponin assessment, those who followed up with a specialist, including a cardiologist, and those who received no follow-up had higher rates of ED revisitation and hospitalization than those who followed-up with the chest pain clinic.

“This is a population with a very low mortality rate,” said Andrew Howarth, MD (University of Calgary, Canada). “They’re seen in the emergency room, worked-up appropriately, and sent home after negative troponins are drawn. They do very, very well. Our data confirm that. Our mortality rate was 0.05% at 30 days. They’re a relatively safe population to send home, but the real issue is emergency-department revisitations and hospitalizations. These are the frequent fliers who keep coming back to the emergency room.”

Presenting the results last week at the American Heart Association Scientific Sessions 2016 in New Orleans, LA, Howarth said the chest pain clinic model, which the province of Alberta is looking to expand, is effective. “The chest pain clinic people are not going back into the emergency room, and they’re not going back into hospital as much as the other groups.”

Among the 28,987 patients discharged from emergency departments across the province between 2012 and 2013, 2,804 were enrolled in one of three chest pain clinics, 4,046 had follow-up with an internist or cardiologist, and 22,137 received no specialist follow-up (these patients were allowed to see their family doctor). At 30 days, the overall incidence of emergency-department revisitation, hospitalization, and death was 1.06%, 2.26%, and 0.05%, respectively. At 90 days, the rates were 9.64%, 4.55% and 0.1%, respectively.

Overall, 0.64% of chest pain clinic patients returned to the emergency department by 30 days compared with 1.36% of patients referred to a cardiologist/internist and 1.06% of patients who received no follow-up. The 30-day hospitalization rates were 1.21%, 2.15%, and 2.41% in the respective three groups. At 60 days, 4.98% of chest pain clinic patients had returned to the emergency department compared with 8.40% of patients referred to a specialist and 10.45% of those with no follow-up. The 90-day hospitalization rates were similar, with chest pain clinic patients having the lowest rate of hospitalization.

“There’s not a lot of them,” said Howarth, referring to the number of chest pain clinics in Alberta, Canada. Some of the clinics are run by cardiologists and others by internists. The workup at these relatively high-volume centers typically involves a focused patient history and physical, with the physician then deciding on the need for further testing. “The primary role of the clinics is to assess people who have pain that is not an acute coronary syndrome,” said Howarth.