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Structure, process and outcomes of chest pain units established in the ESCAPE trial

Jane Arnold1, Steve Goodacre, Francis Morris

  • 1Medical Care Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK. j.a.arnold@sheffield.ac.uk

Emergency Medicine Journal : EMJ
|June 22, 2007
PubMed

Insights

Chest pain units (CPUs) safely manage acute chest pain patients in the NHS, with most discharged after assessment. The ESCAPE trial showed CPUs can be established, but activity varies between hospitals.

Area of Science:

  • Cardiology
  • Health Services Research

Background:

  • Chest pain units (CPUs) offer improved outcomes and reduced costs for acute chest pain care.
  • The ESCAPE (Effectiveness and Safety of Chest Pain Assessment to Prevent Emergency Admissions) trial evaluated CPU establishment in the NHS.

Purpose of the Study:

  • To detail the structure, processes, and patient outcomes within Chest Pain Units (CPUs) participating in the ESCAPE Trial.
  • To assess the feasibility and safety of implementing standardized CPU care across diverse NHS hospitals.

Main Methods:

  • Seven NHS hospitals were randomized to establish CPUs using standardized protocols.
  • Low-risk patients received biochemical cardiac marker and exercise treadmill testing.
  • A 30-day follow-up monitored adverse events, including chest pain-related readmissions, myocardial infarction, and death.

Main Results:

  • Seven CPUs managed 1644 patients in their first year, with activity ranging from 1 to 7 patients per 1000 emergency attendances.
  • 83% of patients were discharged post-CPU assessment, with a low adverse event rate of 1.7% among discharged patients.
  • Hospital size and patient selection influenced CPU activity levels.

Conclusions:

  • Chest pain unit (CPU) care is safely implementable in various NHS settings, facilitating the discharge of most patients.
  • Significant variation exists in patient volume and case mix across different CPU units.
  • Further investigation is needed to understand and address the observed variations in CPU activity.
Abstract

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