Positive impact of an interdisciplinary chest pain initiative on traditionally underserved populations

We assessed the clinical impact of an interdisciplinary, cardiac nurse practitioner-facilitated chest pain (CP) initiative that stresses an early invasive approach for patients with CP with acute coronary syndromes in traditionally underserved patient populations, including females, blacks, Hispanics, and patients older than 60 years.

Two groups of patients were identified: Pre-CP initiative (December 1999-February 2000) and post-CP initiative (December 2000-February 2001).

Analysis of 714 patients revealed significantly more cardiac diagnoses post-CP initiative (61% pre-CP initiative vs. 73% post-CP initiative, P = 0.002), including in patients with myocardial infarction (MI) who were older than 60 years, females, and Hispanics. There was a significant increase in rates of cardiac catheterizations within 1 week of admission (10.5% vs. 20.4%, P <0.001), including in Hispanics. For rates of coronary artery stenting and/or bypass grafting (CABG), there was also a significant increase post-CP initiative (2.5% vs. 10.1%, P = 0.0005), as well as for Hispanics. Length of stay was significantly reduced for patients older than 60 years (8.3 vs. 5.8 days, P = 0.002).

Establishment of an interdisciplinary, cardiac nurse practitioner-facilitated CP initiative is associated with improvement in several clinical processes and outcomes: increased cardiac disease diagnosis in females, Hispanics, and patients older than 60 years; increased rates of cardiac catheterizations in Hispanic patients, increased rates of coronary artery stenting and/or CABG, particularly in Hispanic patients; and decreased length of stay in patients older than 60 years. These data support a targeted interdisciplinary CP initiative as a strategy to systematically enhance access to cardiovascular diagnosis in underserved patient populations.