The American College of Emergency Physicians
For Immediate Release
CONTACT: MJ Fingland, 202-728-0610 ext. 3008
Federal Working Group on Heart Attack Finds Deficiencies in
Some Technologies for Identifying At-Risk Patients; Costs
Nation Approximately $3 Billion
Emergency physicians among those calling for increased support to study
ways to improve diagnostic and triage performance
Many of the 6 million patients who are seen each year in emergency
departments (EDs) complaining of chest pain or related symptoms neither
suffer from nor are at risk of a heart attack. Yet, ineffective evaluation
technologies for diagnosing severe angina or acute cardiac ischemia
(ACI), a precursor to a full-blown heart attack, too often
result in unnecessarily admitting patients to cardiac care, according to a
major study from the National Institutes of Health National Heart Attack
Alert Program (NHAAP) and reported in the January Annals of Emergency
Medicine.
These unnecessary admissions cost the nation approximately $3 billion a
year. In addition, some 20,000 ED chest pain patients who experience
ACI and are at risk of a heart attack are inappropriately sent home. The
report#s authors note that while it is encouraging that there are many
promising technologies for the accurate diagnosis of ACI, very few of
them have been evaluated in the ED--often the first stop for a chest pain
patient--to see whether they are effective and improve patient care.
#In some ways, the glass is both half empty and half full,# said Robert J.
Zalenski, MD, MA, an emergency physician and co-chair of the report#s
working group. #We believe that far more support must be given than has
been the case thus far to study ways to improve diagnostic and triage
performance in hospital emergency departments. Such efforts are
needed to both save lives and contain healthcare costs.#
Also in the January Issue: Following are releases on three related
January Annals articles which look at quality of care, patients# satisfaction
with treatment received in a chest pain observation unit, and
cost-effectiveness of mandatory stress testing of patients in chest pain
centers.
Improving Speed, Accuracy of Emergency Department Triage
Key to Saving Lives and Money in Chest Pain Cases
To counteract problems of unnecessary hospital admissions or
inappropriate discharges for chest pain, physicians from the Medical
College of Virginia have developed a quick, safe, comprehensive medical
strategy to diagnose heart problems. By using a combination of
electrocardiography (ECG), perfusion imaging (using dyes to highlight
certain areas of the heart), and stress evaluation, the physicians found
that they were able to assess patients quickly and accurately on a scale
of one
(minimal risk) to five (immediate risk) of a heart attack, and start
appropriate treatment according to the rating.#A partnership between
emergency medicine physicians and cardiologists is essential for an
institution to develop an optimal strategy for dealing with patients who
come to the ED with chest pain,# said Joseph P. Ornato, MD, an
emergency physician and one of the report#s authors.
Emergency Department Chest Pain Observation Units Preferred
by Patients Over Hospital Inpatient Care
Patients suffering serious chest pain who were assessed in an ED
ambulatory chest pain observation unit (CPOU) were more satisfied with
the care and rapid diagnosis they received than were chest pain patients
who were admitted for an inpatient observation.
Patients were assigned to either the CPOU or the inpatient
hospitalization, and asked to rate their treatment on communication,
fulfillment of special needs/preferences, and physical comfort. The
CPOU scored higher in all categories.
#Assessing the value of a procedure only on cost and outcome misses
the equally important variable that is the patient#s perception of that
procedure,# said the study#s lead author, Robert J. Rydman, Ph.D. #This
study pointed out that by addressing a few key processes, emergency
physicians have learned what is important to their chest pain patients,
thereby providing them an opportunity to make significant and positive
differences in how their patients perceive the type of care they receive.#
Requiring Stress Testing of Chest Pain Center Patients
Cost-Effective
Procedure shown to be a safe, reliable diagnostic and
prognostic tool for heart attack
Stress testing patients suffering with acute chest pain from uncertain
causes, who are referred to ED chest pain centers (CPCs), can greatly
reduce the chances of missing life-threatening heart problems. In
addition, as much as 62 percent cost-per-case was saved for each
patient by referring them to the CPC for outpatient evaluation versus
hospitalization for evaluative purposes.
In a study of 502 ED patients with serious chest pain but at low risk of
heart attack who were
transferred to a CPC, 424 (84 percent) of the 430 that were discharged
were stress tested with negative findings. Of these discharged patients,
100 percent survived and none had been
diagnosed with a heart attack in the five months following discharge.
#Chest pain centers offer an opportunity for timely prevention of heart
attacks through the creation of procedures that include mandatory stress
testing. Such procedures will ensure that chest pain patients are
accurately diagnosed and treated,# said Michael G. Mikhail, MD, an
emergency physician and the study#s lead author.
-Some Teen Visits to EDs May Indicate Depression
Teens going to EDs for nonspecific medical problems are rarely
screened for depression, but they should be, say some emergency
physicians. Suicide is the third leading cause of death among
adolescents, and statistics show that nearly half of adolescents who
attempt suicide seek some form of medical attention in the month before
the attempt, and a quarter seek medical care a week before their attempt.
The study, lead by Stephen Porter, MD, reports that in reviewing cases
of 408 adolescent patients seen for physical complaints over a
four-month period in the ED, few of the adolescents were screened for
depression or thoughts of suicide.
The authors express hope that the chart entry omissions may not reflect
an accurate picture of whether such questioning had occurred, but note
that emergency physicians can facilitate further evaluation or referral of
at-risk adolescents by asking and documenting a few well-chosen
questions.
Annals of Emergency Medicine is the peer-reviewed journal of the
American College of Emergency Physicians, a national medical specialty
society representing more the 19,000 physicians who specialize in
emergency medicine. The College is committed to improving the quality of
emergency care through continuing education, research, and public
education.
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